Perampanel monotherapy may offer small additional benefits for sleep architecture compared to levetiracetam in children with SeLECTS, including a lower proportion of N1 sleep and a greater reduction in the number of awakenings.
In a pilot prospective cohort study of 35 children with SeLECTS, perampanel (PER) monotherapy was associated with a significantly lower proportion of N1 sleep (10.15% vs 12.03%, P=0.039) and a greater reduction in the number of awakenings (mean change -2.68 vs 1.13, P=0.036) compared to levetiracetam (LEV) at follow-up. Both drugs were tolerated and achieved short-term seizure control, with no significant differences in subjective sleep quality, daytime sleepiness, or quality of life.
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Perampanel monotherapy may offer small additional benefits for sleep architecture compared to levetiracetam in children with SeLECTS, including a lower proportion of N1 sleep and a greater reduction in the number of awakenings. The current body of evidence comprises 1 study. EvidenceHub rates the overall confidence at 34/100 (low).
The Claim
Perampanel monotherapy may offer small additional benefits for sleep architecture compared to levetiracetam in children with SeLECTS, including a lower proportion of N1 sleep and a greater reduction in the number of awakenings.
This conclusion is most relevant to: Children aged 6-12 years with self-limited epilepsy with centrotemporal spikes (SeLECTS) receiving monotherapy.
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Efficacy and sleep impact of perampanel versus levetiracetam monotherapy for SeLECTS: A pilot prospective cohort study. (Epilepsy & behavior : E&B, 2026) —
How It Works
The proposed biological pathway:
- ▸Perampanel acts as a selective non-competitive AMPA receptor antagonist, reducing excitatory neurotransmission.
- ▸Reduced excitability may stabilize sleep architecture, particularly decreasing light sleep (N1) and reducing sleep fragmentation.
- ▸Levetiracetam, while also effective, may have a different effect on sleep microstructure.
- ▸Result: PER group showed lower N1 proportion and greater reduction in awakenings compared to LEV.
Who Might Benefit
Evidence fit by population:
- ▸Children aged 6-12 years with self-limited epilepsy with centrotemporal spikes (SeLECTS) receiving monotherapy
Recommended Dose
N/A (doses not specified in abstract)
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Pilot study with small sample size (n=35) and short follow-up (median ~4-5 months).
- ▸Baseline differences in spike-wave index (SWI) between groups (PER had higher SWI) may confound results.
- ▸Non-randomized design (prospective cohort) limits causal inference.
- ▸No blinding or placebo control.
Frequently Asked Questions
What is SeLECTS?▼
Self-limited epilepsy with centrotemporal spikes (SeLECTS) is a common childhood epilepsy syndrome with sleep-related epileptiform discharges.
Which drug is better for sleep in children with SeLECTS, perampanel or levetiracetam?▼
Perampanel showed small benefits in sleep architecture (lower N1 sleep and greater reduction in awakenings) compared to levetiracetam, but both drugs were effective for seizure control and had similar subjective sleep outcomes.
How was sleep measured in this study?▼
Sleep was measured using polysomnography (objective parameters like N1 proportion and awakenings), the Children's Sleep Habits Questionnaire (CSHQ), and the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD).
Are there any side effects of perampanel or levetiracetam in children?▼
The abstract states both drugs were tolerated, but specific adverse drug reactions were recorded but not detailed in the abstract.
References
- 1.Yan L, Xie L, Li T, Chen J, Jiang L. “Efficacy and sleep impact of perampanel versus levetiracetam monotherapy for SeLECTS: A pilot prospective cohort study..” Epilepsy & behavior : E&B, 2026. PMID: 42570407 DOI: 10.1016/j.yebeh.2026.111228