We aim to analyze effect of perampanel on insomnia within epilepsy patients.

Recently, there are articles suggesting perampanel may increase sleep quality in epilepsy patients. However, there is no study demonstrating the relationship between perampanel and insomnia. Through this study we analyzed effect of the perampanel on insomnia within epilepsy patients.

This study is a cross-sectional study conducted in Asan Medical Center with 126 patients. Insomnia Severity Index(ISI), Patient Health Questionnaire-9(PHQ-9), Generalized Anxiety Disoreder-7(GAD-7), Epworth Sleepiness Scale(ESS), sleep apnea(STOP-BANG) were obtained through questionnaires. The patient who took perampanel more than 16 weeks were sorted to 'On-perampanel' group and those who did not took any into 'No-perampanel' group. Basic profile of the participants and epilepsy-related factors were included as co-variables. Univariate analysis was done to see the correlation between perampanel usage and insomnia. Multiple linear regression was done to analyze the factor correlating with insomnia while adjusted by possible confounding factors. Independent variable was set as ISI score and dependenet variables as factors with p<0.1 on univariate analysis. Analysis of covariance was done for analyzing interaction between perampanel and factors with p<0.05 in multiple linear regression.

 Univariate anaylsis did not show correlation between ISI scores and perampanel(p=0.46). However, through multiple linear regression, PHQ-9≥10(B=5.515, p=0.000),  GAD-7≥7(B=4.515, p=0.002) and perampanel(B=-3.729, p=0.003) have shown correlation with ISI scores. Adjusted confounding variables were ESS score, valproic acid, carbamazepine, age of seizure onset, number of AEDs, noctural seizure, seizure type and frequency. Analysis of covariance showed anxiety-by-perampanel interaction with insomnia clinically significant(p=0.029). Within the patients with anxiety, perampanel had effect of lowering ISI scores(B=-5.909, p=0.001) and for those without anxiety, perampanel's effect was not significant(p=0.431).

Perampanel may improve insomnia through a decrease in anxiety in patients with epilepsy. Thus, clinical physicians should consider prescribing perampanel in patients with epilepsy who suffer from both insomnia and anxiety.