Purpose To review psychiatric and behavioural events in a study conducted to evaluate the efficacy and safety of adjunctive perampanel in patients with uncontrolled primary generalised tonic-clonic seizures (PGTCS).

Method Following baseline (4 or 8 weeks), patients aged ≥12 years were randomised to double-blind treatment with perampanel or placebo (titration 4 weeks; maintenance 13 weeks; maximum dose 8 mg). Treatment-emergent adverse events (TEAEs) were evaluated using MedDRA search terms for psychiatric disorders and MedDRA SMQs for hostility/aggression-related events.

Results In the Safety Analysis Set (perampanel n=81; placebo n=82), psychiatric TEAEs occurred in 20 (24.7%) perampanel- and 16 (19.5%) placebo-treated patients. Most TEAEs were of mild or moderate intensity. Frequency of TEAEs related to hostility/aggression was 18.5% for perampanel and 4.9% for placebo, largely due to a higher rate of irritability with perampanel (11.1%) versus placebo (2.4%). Incidences of serious adverse events and discontinuations due to TEAEs related to hostility/aggression for perampanel versus placebo were 1.2% versus 0% and 3.7% versus 1.2%, respectively.

Conclusion Consistent with results from Phase III trials in partial epilepsy, hostility/aggression-related TEAEs occurred at a higher rate in perampanel-treated patients with PGTCS than in those treated with placebo, driven mainly by irritability.

Supported by Eisai Inc.