Introduction: Medical therapy is the mainstay of management of epilepsy. Despite the increasing
number of available antiepileptic drugs (AEDs), approximately one-third of epileptic patients do not
have adequate control of seizures. There is still a need for the development of new AEDs with enhanced
effectiveness and tolerability.
Areas covered: The present manuscript is based on an Internet and PubMed search (January 2005 to
August 2018). It is focused on pharmacokinetic and clinical data of perampanel (PER) for the treatment
of epilepsy.
Expert opinion: PER has a novel mechanism of action, which opens up new options for a rational
combination therapy. Phase III trials have demonstrated the efficacy and safety of PER as adjunctive
therapy for the treatment of partial-onset seizures (POS) and primary generalized tonic–clonic seizures
in patients aged ≥12 years. PER is also approved by FDA as monotherapy for the treatment of POS.
A clinical trial is ongoing to verify the efficacy and safety of PER monotherapy in untreated patients with
POS. In the future, head-to-head comparisons are needed to determine the exact position of PER
relative to other AEDs. Moreover, further studies are needed to evaluate the efficacy and safety of PER in
patients aged <12 years.
