Current role of perampanel in pediatric epilepsy
Paola De Liso1, Romina Moavero2,3, Giangennaro Coppola4
1Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Piazza S. Onofrio 4, 00165, Rome, Italy.
Insights
Perampanel is an effective antiepileptic drug (AED) for specific seizure types in patients 12 and older. Careful titration minimizes adverse events, offering a new treatment option for adolescents with epilepsy.
Area of Science:
- Neurology
- Pharmacology
Background:
- Perampanel is a newer antiepileptic drug (AED) approved for specific seizure types.
- It is indicated for partial-onset seizures and primary generalized tonic-clonic seizures in patients aged 12 years and older.
Purpose of the Study:
- To summarize clinical recommendations for perampanel in pediatric epilepsy treatment.
- To discuss future research directions for perampanel.
Main Methods:
- Review of clinical recommendations and available data on perampanel.
- Analysis of dosage, efficacy, and adverse event profiles.
Main Results:
- Optimal dosage ranges from 4-12 mg/day, with 8 mg/day commonly used.
- Slow titration from low doses reduces adverse events, including psychiatric symptoms.
- Perampanel shows an acceptable risk/benefit ratio, with caution advised for seizure aggravation and behavioral issues.
Conclusions:
- Perampanel offers advantages like a favorable cognitive profile and once-daily dosing, suitable for adolescents.
- Its novel mechanism of action provides a new approach to epilepsy management, particularly in adolescents.
Abstract:
Perampanel is among the latest AEDs approved, indicated for the treatment of partial-onset seizures with or without secondary generalization, and for primary generalized tonic-clonic seizures, in patients aged 12 years and older. This paper summarizes the clinical recommendations on the current role of perampanel in the treatment of pediatric epilepsies and future directions for research. The optimal dosage should be comprised between 4 and 12 mg/day, with 8 mg/day being the most common dosage used. The rate and severity of adverse events, including psychiatric symptoms, can be decreased by starting at low doses, and titrating slowly. Overall, perampanel presents an acceptable risk/benefit ratio, but special caution should be made to the risk of seizure aggravation and behavioral problems. The favorable cognitive profile, the ease of use of the titration scheme and the once-daily formulation offer advantage over other AEDs and make this drug particularly suitable for adolescent population. Perampanel is a welcome addition to the armamentarium of the existing AEDs, as it represents a new approach in the management of epilepsy, with a novel mechanism of action and a potential to have a considerable impact on the treatment of adolescents with epilepsy.
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