Summary

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• Fycompa (perampanel) is indicated for the treatment of partial-onset seizures with or without secondarily generalized seizures in patients with epilepsy 4 years of age and older, and for adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in patients with epilepsy 12 years of age and older.
• This summary is based on the review of 17 systematic reviews/meta-analyses. ^[1-18]
• Lacosamide (LCM) significantly increases the risk of arrhythmias compared to Levetiracetam (LEV).
• Eslicarbazepine acetate (ESL) demonstrated the highest effectiveness in reducing seizure frequency, while Cenobamate (CNB) had the best 50% responder rate among the evaluated antiseizure medications (ASMs).
• Perampanel (PER) was effective in reducing seizure frequency in drug-resistant focal epilepsy with a relative risk (RR) of 1.67.
• Perampanel (PER) showed higher rates of irritability, anger, and aggression compared to other ASMs such as Brivaracetam (BRV), Levetiracetam (LEV), and Topiramate (TPM).
• Perampanel (PER) was associated with a higher incidence of psychiatric and behavioral adverse events, including irritability, anger, and aggression, compared to some other antiepileptic drugs (e.g., Brivaracetam, BRV).
• In pediatric populations, common adverse events related to PER included drowsiness, irritability, and dizziness, with an increased risk of movement disorders noted.
• Higher doses of PER (e.g., 12 mg/day) were linked to an increased occurrence of adverse events, highlighting a dose-related safety concern.
• Perampanel (PER) efficacy is notable in specific populations such as children and adolescents, brain tumor-related epilepsy (BTRE), and drug-resistant epilepsy, with higher responder rates and seizure freedom reported. However, common adverse events include drowsiness, irritability, and dizziness in pediatric populations, and dose-related adverse effects in drug-resistant epilepsy. Additionally, PER shows better responder rates in patients with focal-onset seizures when used with concomitant LEV, and has potential broad-spectrum efficacy in generalized seizures with no significant patterns of seizure worsening. Limited evidence is available for PER use in status epilepticus.