Perampanel-Induced Cataplexy in a Young Male with Generalized Epilepsy

Authors

Kelsey Kenaan, Edward Via College of Osteopathic MedicineFollow
Mohsin Zafar, Orange Park Medical CenterFollow
Ronnie Bond, Orange Park Medical CenterFollow
Barbara L. Gracious, Orange Park Medical CenterFollow

Keywords

cataplexy; narcolepsy; disorders of excessive somnolence; sleep wake disorders; perampanel; Fycompa; orexins; hypocretin; seizures; epilepsy; REM sleep behavior disorder; drug-related side effects and adverse reactions

Disciplines

Medical Neurobiology | Neurology | Neurosciences | Other Pharmacy and Pharmaceutical Sciences | Psychiatry | Psychological Phenomena and Processes

Abstract

Perampanel (Fycompa) is a newer anti-epileptic drug believed to exert its effects in the central nervous system by inhibiting post-synaptic glutamate receptors. However, the precise therapeutic mechanism is unknown. The most common neuropsychiatric side effect is affective dysregulation; there are also reports of psychosis. We describe a 32 year old African American male with recurring generalized tonic-clonic (GTC) seizures, who presented to our hospital with onset of mood lability for several months, after Perampanel was added to his antiepileptic medications. Perampanel administration was temporarily withheld, and subsequently on restarting, noted to be coincident with neuropsychiatric symptomatology, including motor weakness in emotional contexts. The mechanisms underlying cataplexy are complex and, in our patient, most likely induced by an interaction between Perampanel and the wakeful inhibition of the sublaterodorsal nucleus projections.

Recommended Citation

Kenaan, Kelsey; Zafar, Mohsin; Bond, Ronnie; and Gracious, Barbara L. (2020) "Perampanel-Induced Cataplexy in a Young Male with Generalized Epilepsy," HCA Healthcare Journal of Medicine: Vol. 1: Iss. 5, Article 5.
DOI: 10.36518/2689-0216.1040
Available at: https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol1/iss5/5