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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.

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.

Last updated: Aug 23, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Efficacy and sleep impact of perampanel versus levetiracetam monotherapy for SeLECTS: A pilot prospective cohort study.

observational

Yan L, Xie L, Li T, Chen J, Jiang L · Epilepsy & behavior : E&B (2026)

Participants: N/A
Duration: Median follow-up ~4-5 months (128-144.5 days)
Intervention: Perampanel monotherapy compared to levetiracetam monotherapy
Outcome: Sleep architecture (proportion of N1 sleep, number of awakenings), seizure frequency, EEG normalization, subjective sleep quality (CSHQ), daytime sleepiness (ESS-CHAD), quality of life (QOLCE-16)
Effect Size: N/A (only P-values reported)
Population: Children aged 6-12 years with self-limited epilepsy with centrotemporal spikes (SeLECTS) receiving monotherapy

Result:

PubMed: 42570407DOI: 10.1016/j.yebeh.2026.111228

Mechanism Graph

Perampanel acts as a selective non-competitive AMPA receptor antagonist, reducing excitatory neurotransmission.
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Reduced excitability may stabilize sleep architecture, particularly decreasing light sleep (N1) and reducing sleep fragmentation.
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Levetiracetam, while also effective, may have a different effect on sleep microstructure.
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Result: PER group showed lower N1 proportion and greater reduction in awakenings compared to LEV.

Limitations

  • ⚠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.

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References

  1. 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
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.