Optimal Use of Perampanel in Elderly Asian Patients with Epilepsy: Expert Opinion

Abstract

Managing epilepsy in the elderly remains complicated largely due to factors related to aging. In this population, management practices are increasingly shifting towards the use of newer-generation anti-seizure medications (ASMs) as they are generally associated with better tolerability and safety profiles than older ones. Perampanel is a new ASM with broad-spectrum efficacy and a favorable safety profile. However, because of the lack of information and experience in its use, the prescription of perampanel has not been optimized in the elderly in the real-world setting in Asia. A group of epilepsy experts across the region convened at a series of virtual meetings to share their experience and discuss recommendations on perampanel use in elderly patients, including dose optimization, considerations with treatment initiation, and strategies to manage adverse events and maximize tolerability. This article summarizes key clinical and real-world evidence for perampanel in the elderly and consolidates the experts’ opinions on optimizing perampanel use in elderly Asian patients with epilepsy, providing practical guidance for clinicians to address challenges related to treatment initiation and tolerance.

WRAPPER study: Real‐world effectiveness and tolerability of adjunctive perampanel for people with drug–resistant epilepsy in Hong Kong

“…This trend of better seizure control in elderly Asians with perampanel has also been observed by epilepsy experts across Asia such that an expert opinion article was published in 2022. 23 Regarding tolerability, mean retention time in WRAPPER was 44.5 weeks (SD 1.7, 95% CI 41.2-47.8) comparable to that of PERMIT at 43.2 weeks (95% CI 42.4-43.6). Seizure exacerbation was the most common adverse effect at 35.7% (25/70) at 16 weeks.…”

“…This trend of better seizure control in elderly Asians with perampanel has also been observed by epilepsy experts across Asia such that an expert opinion article was published in 2022. 23 …”