Epilepsy is a common chronic disease of the nervous system, which has certain adverse effects on the cognitive, psychological and social functions of the patients. To date, anti-seizure medications (ASMs) remain the first-line treatment option for epilepsy, but many patients with epilepsy still do not have effective seizure control when multiple ASMs are used in combination. Therefore, there is an urgent need for a new target and mechanism ASMs to bring about new treatment options and hope for patients with intractable epilepsy. Perampanel, a new third-generation ASMs, whereas second-generation ASMs tend to exert anti-seizure effects mainly by regulating ion channels or enhancing related mechanisms such as gamma-aminobutyric acid (GABA) effects, perampanel exerts its effects mainly by targeting the excitatory neurotransmitter glutamate. Perampanel is the first selective α-amino-3-hydroxy-5-methyl-4-isoxazole-propionate (AMPA) receptor antagonist and the first selective inhibitory ASMs for excitatory postsynaptic function. Because of its unique target and mechanism, it has been approved by many countries in the world for adjuvant additive therapy and monotherapy for patients with focal and general epilepsy. In addition, with the discovery of the neuroprotective, antioxidant, neurotransmitter regulation effects of perampanel, it also provides a new potential choice for the treatment of other diseases. This article mainly reviews the mechanism of action, pharmacokinetics, clinical trials and treatment of other diseases other than epilepsy of perampanel.
ObjectiveTo evaluate the clinical efficacy and safety tolerance of perampanel in the treatment of Chinese adult epilepsy patients. Methods Clinical data of adult epileptic patients treated with perampanel in Department of Neurology, China-Japan Union Hospital of Jilin University from January 2020 to December 2022 were analyzed retrospectively by self-control method, including demographic and clinical characteristics of patients, changes of epileptic seizures before and after perampanel treatment and adverse events during the treatment of perampanel. To evaluate the clinical efficacy and safety of perampanel in Chinese adult epileptic patients. Results A total of 69 adult epileptic patients with complete follow-up data were included. The dosage range of perampanel was 2 ~ 8 mg. The total effective rate was 68.1%, and the seizure-free rate was 17.4%. The most common adverse reactions were mood change and dizziness, the incidence of adverse reactions was 52.2%, and the incidence of serious adverse reactions was 0.0%. In terms of analysis of influencing factors of efficacy, the results showed that single drug therapy or combination therapy, type of combined antiepileptic drug and treatment time of perampanel did not affect the efficacy (P>0.05), while dosage was an important factor affecting the efficacy of perampanel (P<0.05), and there was no significant difference in efficacy between the focal epilepsy group and the general epilepsy group (P>0.05). In terms of the analysis of factors related to the occurrence of adverse reactions, the results showed that the occurrence of adverse reactions was related to the dosage of perampanel (P<0.05), and was independent of whether it was monotherapy, the addition time of perampanel and the type of combined antiepileptic agents (P>0.05). Conclusion Perampanel has good efficacy and safety tolerance in the treatment of epilepsy in Chinese adults. Both monotherapy and additive therapy can effectively control seizures, and has a good effect on different seizure types. The most common adverse events during treatment were mood changes and dizziness, which could be alleviated and tolerated by most patients with prolonged treatment.