Perampanel for the treatment of primary generalized tonic-clonic seizures in idiopathic generalized epilepsy

Abstract

A placebo-controlled clinical phase III study including 164 patients (≥ 12 years) with pGTCS in idiopathic generalized epilepsies (IGE) demonstrated efficacy of PER in reducing pGTCS with good tolerability profile, and without aggravating absence seizures or myoclonic seizures. Dizziness, the main adverse event (AE), can be avoided by bedtime administration. Psychiatric AEs ranging from mild depression to aggression and suicidal attempts should be especially monitored in patients with a history of psychiatric disorders. Co-administration of enzyme inducing antiepileptic drugs (AEDs) might decrease PER plasma levels and make dose adjustment necessary. A reduced efficacy of progesterone-containing oral contraceptives should be considered when administering PER to young women. There is lack of evidence on PER treatment in pregnancy. Although no teratogenic effects were observed in animal models, PER is not recommended for women of childbearing age without contraception.

Perampanel: Does it have broad‐spectrum potential?

“…PGTC seizures are the most severe type of seizure, with potentially life‐threatening consequences, including SUDEP, so new therapies for these patients are important . Four AEDs have ILAE class I evidence as adjunctive treatment for PGTC seizures: perampanel, levetiracetam, lamotrigine, and topiramate .…”

“…PGTC seizures are the most severe type of seizure, with potentially life‐threatening consequences, including SUDEP, so new therapies for these patients are important . Four AEDs have ILAE class I evidence as adjunctive treatment for PGTC seizures: perampanel, levetiracetam, lamotrigine, and topiramate . However, the place of perampanel in the treatment hierarchy is hard to determine given the lack of studies directly comparing perampanel with other AEDs and the differences (eg, methods, patient populations, endpoints) in the trials comparing other AEDs with placebo .…”

“…Four AEDs have ILAE class I evidence as adjunctive treatment for PGTC seizures: perampanel, levetiracetam, lamotrigine, and topiramate . However, the place of perampanel in the treatment hierarchy is hard to determine given the lack of studies directly comparing perampanel with other AEDs and the differences (eg, methods, patient populations, endpoints) in the trials comparing other AEDs with placebo . Table shows the results of RCTs in patients with generalized seizures, including PGTC seizures …”

Perampanel in the treatment of drug-resistant epilepsy in children

“…Одним из новейших АЭП является перампанел (фай-компа), зарегистрированный в Российской Федерации в 2013 г. Показание к применению перампанела -до-полнительная терапия у пациентов в возрасте от 12 лет и старше с фокальными и генерализованными приступами [17]. Механизм антиэпилептического действия перампанела -высокоселективное некон-курентное ингибирование AMPA-рецепторов глу-тамата (основного возбуждающего нейромедиатора центральной нервной системы), расположенных в постсинаптических мембранах нейронов на уровне неокортекса и гиппокампа [11,17]. Благодаря высоко-селективному механизму действия перампанел обла-дает ограниченным числом нежелательных явлений, которых можно избежать путем увеличения времени титрации или снижения дозы [3].…”

The Formation of Cognitive and Mental Disorders in Epilepsy: The Role of Various Factors Associated With Disease and Treatment (A Review of Literature and Case Reports)

“…Голово-кружение -основной ПЭ перампанела -уменьшается при приеме препарата непосредственно перед сном, в постели. Риск психиатрических ПЭ перампанела, варьирующих от легкой депрессии до агрессии и по-пыток суицида, повышен у пациентов с психическими нарушениями в анамнезе, поэтому у этой категории пациентов препарат нужно назначать с особенной осторожностью [68].…”