Perampanel for focal epilepsy: insights from early clinical experience

Trinka, E., Steinhoff, B.J., Nikanorova, M. and Brodie, M.J. (2016) Perampanel for focal epilepsy: insights from early clinical experience. Acta Neurologica Scandinavica, 133(3), pp. 160-172. (doi: 10.1111/ane.12529) (PMID:26506904) (PMCID:PMC4738453)

Abstract

Perampanel is approved for adjunctive therapy of focal epilepsy with or without secondarily generalized seizures in patients aged >12 years. This narrative review uses real-world and clinical trial data to elucidate perampanel's role in the clinic. Audit data show good tolerability with perampanel and higher freedom-from-seizure rates in elderly vs younger patients. When using perampanel in elderly patients, special attention should be given to comorbidities and co-medication to avoid potential interactions or adverse events. Slower titration is generally recommended, and seizure control should be reassessed at a dose of 4 mg before further dose increases. Perampanel efficacy is similar in adolescents and adults; however, somnolence, nasopharyngitis, and aggression are more frequent in adolescents vs the overall population. Individualized and slow-dose titration can minimize adverse events. Low serum concentrations of perampanel may occur in patients also receiving some enzyme-inducing anti-epileptic drugs; a perampanel dose increase may be required. Adverse events of importance with perampanel include dizziness; anger, aggression, and hostile behavior (particularly in adolescents); and falls (particularly in patients >65 years). An individualized approach to dosing, including slower up-titration and bedtime dosing, reduces dizziness risk. Other drugs may cause or aggravate dizziness; reducing concomitant drugs may be necessary when up-titrating perampanel. It would seem clinically appropriate to give due consideration to avoiding use in patients with a history of anger or hostile/aggressive behavior. The possibility of such behaviors should be discussed with patients before starting perampanel, with monitoring during up-titration. Slower up-titration of perampanel in older patients helps reduce fall risk.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Brodie, Professor Martin
• Authors: Trinka, E., Steinhoff, B.J., Nikanorova, M., and Brodie, M.J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Acta Neurologica Scandinavica
• Publisher: Wiley
• ISSN: 0001-6314
• ISSN (Online): 1600-0404
• Published Online: 28 October 2015
• Copyright Holders: Copyright © 2015 The Authors
• First Published: First published in Acta Neurologica Scandinavica 133(3): 160-172
• Publisher Policy: Reproduced under a Creative Commons License