Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements

• Published in: BMC neurology Vol. 21; no. 1; p. 410
• Main Authors: Bonanni, Paolo, Gambardella, Antonio, Tinuper, Paolo, Acone, Benedetto, Perucca, Emilio, Coppola, Giangennaro
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26.10.2021; BioMed Central; BMC
• Subjects: Adjunctive therapy; Adult; Anticonvulsants - therapeutic use; Antiepileptic drugs; Child; Cognitive ability; Consensus; Convulsions & seizures; Delphi procedure; Drug dosages; Drug therapy; Enzymes; Epilepsy; Humans; Italy; Nitriles; Pediatrics; Perampanel; Practice guidelines (Medicine); Pyridones - therapeutic use; Quality of Life; Remission; Retention; Seizures; Seizures (Medicine); Titration; Treatment Outcome; Italy; Delphi procedure; Adjunctive therapy; Antiepileptic drugs; Epilepsy; Perampanel
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-021-02450-y

When use of a single antiseizure medication (ASM) fails to induce seizure remission, add-on therapy is justified. Perampanel (PER) is approved in Europe as adjunctive therapy for focal, focal to bilateral tonic-clonic seizures and generalized tonic-clonic seizures. Aim of the study was to establish whether PER is suitable for first add-on use. A Delphi methodology was adopted to assess consensus on a list of 39 statements produced by an Expert Board of 5 epileptologists. Using an iterative process, statements were finalized by a Delphi Panel of 84 Italian pediatric and adult neurologists. Each statement was rated anonymously to determine level of agreement on a 9-point Likert scale. Consensus was established as agreement by at least 80% of the panelists. The relevance of each statement was also assessed on a 3-point scale. Consensus was achieved for 37 statements. Characteristics of PER considered to justify its use as first add-on include evidence of a positive impact on quality of life based on long term retention data, efficacy, tolerability, and ease of use; no worsening of cognitive functions and sleep quality; a low potential for drug interactions; a unique mechanism of action. Potential unfavorable factors are the need for a relatively slow dose titration; the potential occurrence of behavioral adverse effects; lack of information on safety when used in pregnancy; limited access to plasma PER levels. Perampanel has many features which justify its use as a first add-on. Choice of an ASM as first add-on should be tailored to individual characteristics.