Summary

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• This summary is based on the review of 20 systematic review(s)/meta-analysis(es). ^[1-20]
• Perampanel (PER) in Drug-Resistant Focal Epilepsy: PER achieved ≥50% seizure frequency reduction compared to placebo (RR (relative risk) 1.67; high-certainty evidence), with higher doses (8 mg/day and 12 mg/day) showing increased effectiveness (RR 1.83 and 2.38, respectively). Seizure freedom was also improved with PER (RR 2.50; low-certainty evidence).
• Perampanel in Idiopathic Generalized Epilepsies (IGEs): PER demonstrated the highest safety ranking among antiepileptic medications for treatment-emergent adverse events (TEAEs).
• Perampanel in Brain Tumor-Related Epilepsy (BTRE): Achieved high responder rates (75%-95%) and seizure freedom rates (up to 94%) with favorable tolerability.
• Comparison of Cenobamate (CNB) and Brivaracetam (BRV): CNB showed higher efficacy in responder rate and seizure freedom compared to PER and other antiseizure medications (ASMs), though with similar TEAE rates. BRV had better tolerability with fewer TEAEs than PER, especially regarding dizziness.
• Common adverse effects of PER included dizziness, somnolence, behavioral issues (e.g., irritability, aggression), fatigue, and weight gain, with higher treatment-emergent adverse event rates at doses of 8 mg/day and 12 mg/day, and increased treatment withdrawals due to adverse effects at 12 mg/day.
• In children and adolescents with refractory epilepsy, behavioral adverse effects were more frequent, particularly with high doses and rapid titration. For BTRE, non-severe adverse effects were reported in 11%-52% of patients, with a low rate of discontinuation due to adverse events.
• Compared to other antiepileptic drugs, BRV had better tolerability than PER, with a lower incidence of TEAEs.
• Retention rates in children and adolescents were 65%-77%, with a 70% response rate (compared to 52% in adults) and seizure-free rates of 25% in children/adolescents versus 37% in adults; cognitive outcomes generally showed no impairment, with slight verbal memory improvement and attentional decline; high responder rates (75%-95%) and tolerability in BTRE were noted, while progressive myoclonic epilepsies (PMEs) showed significant improvements in action myoclonus and daily independence, especially in Unverricht-Lundborg disease.