Perampanel Monotherapy in Epileptic Children: A Systematic Review with Pooled Descriptive Analysis

This systematic review with a pooled descriptive analysis aimed to improve our understanding of perampanel monotherapy for epilepsy in children today. The databases were created following a PubMed search, adhering to PRISMA guidelines. A total of 12 studies from 74 citations published between 2016 and 2026 met the specified inclusion criteria. The pooled descriptive analysis featured 8 retrospective and 4 prospective observational studies, accounting for 850 children with epilepsy. The ages of participants at the time of data acquisition varied from 2 to 16 years. The patterns of seizures observed were predominantly focal seizures, comprising 86.71% of cases. The maintenance dose of perampanel ranged from 1.5 to 12.0 mg per day. Concerning outcome, perampanel monotherapy showed high responder rates, seizure freedom, and retention rates at 3, 6, and 12 months post-treatment, while also maintaining a tolerable safety profile for children. After evaluating heterogeneity, the retention, responder, and seizure freedom rates at 12 months were 79% (95% CI: 73%-85%; n = 7), 78% (95% CI: 71%-85%; n = 6), and 72% (95% CI: 69%-79%; n = 7), respectively. The absence of a significant difference between the estimates from pooled raw data and the data analyzed after assessing heterogeneity indicated that the underlying variances do not significantly alter the overall effect estimates. The non-randomized nature of the included studies limited the ability to draw definitive causal inferences. In conclusion, perampanel could be an effective initial monotherapy for children diagnosed with epilepsy.