Neuropsychiatric Disease and Treatment (Sep 2019)
An Evidence-Based Review On The Use Of Perampanel For The Treatment Of Focal-Onset Seizures In Pediatric Patients
Abstract
Blandine Dozières-Puyravel,1 Stéphane Auvin1,2 1Service de Neurologie Pédiatrique et des Maladies Métaboliques, Hôpital Robert Debré, Paris, France; 2Université Paris Diderot, Sorbonne Paris Cité, INSERM UMR 1141, Paris, FranceCorrespondence: Stéphane AuvinService de Neurologie Pédiatrique et des Maladies Métaboliques, CHU Hôpital Robert Debrém, 48, Boulevard Sérurier, Paris CEDEX 19- 75935, FranceTel +33 1 40 03 57 24Fax +33 1 40 03 47 74Email [email protected]: Perampanel, a non-competitive AMPA receptor antagonist, is a once-daily oral antiepileptic drug approved for the treatment of focal seizures and primary generalized tonic–clonic seizures in children 12 years of age and over. We conducted a systematic review of the data on perampanel in children and adolescents with focal-onset seizures. We found 21 published papers on the pediatric use of perampanel for focal-onset seizures, including 9 papers on clinical trials and ancillary studies of these trials, of which 2 focused on pharmacokinetics, 1 was a meta-analysis, and 9 were real-life studies (1 was prospective). Perampanel, as an adjunctive treatment for uncontrolled focal-onset seizures, results in an improvement of seizure control with a generally good safety profile. Evidence-based data are currently available for children 12 years of age and over. Higher amounts of perampanel might be required in patients taking enzyme-inducing antiepileptic drugs. The most common adverse events are somnolence, dizziness and behavioral adverse events. The latter seems more frequent in adolescents than in adults and in adolescents with preexisting behavioral comorbidities. Current studies did not identify any short-term impact of perampanel on cognitive functions. Its long half-life allows once-daily administration. Real-life studies further established that a decrease of the dose frequently resolves adverse events, as demonstrated in pivotal studies. Pharmacokinetic and safety studies are still ongoing in the younger population, down to 4 years of age, in order to apply for approval in this age group.Keywords: antiepileptic drugs, children, epilepsy, focal onset seizure, perampanel
