Perampanel as first line monotherapy for seizure in japan. A single-centre real-world study.

Aims: The aim of this study was to examine the efficacy of Perampanel (PER) monotherapy for patients with seizures in a single-centre in Japan. The National Health Insurance began covering PER monotherapy in Japan since January 2020, after which we began using PER as monotherapy for patients with epilepsy at our institute.

Methods: All patients given PER between January 2020 and December 2022 were evaluated in this retrospective study. Treatment outcomes (including the seizure rate and seizure- free status) and patient sex, seizure type, and seizure aetiology were evaluated.

Results: Sixty-three patients (29 females, 34 males) receiving PER monotherapy as the first-line antiseizure medication for epilepsy were evaluated. The age range was 12 to 88 years, with a mean age of 64.5 ± 18.8years. The follow-up period ranged from 194 days to 1004days, with a median of 576 days from PER initiation. A total of 49 patients (77.8%) were seizure free, while the other 14 patients had incomplete seizure control, including 2 patients (3.2%) who had a 75-99% reduction in seizures, 4 patients (6.3%) who had a 50-74% reduction in seizures,8 patients (12.7%) who had a 25-49% reduction in seizures, and no patients with a 0-24% reduction in seizures. The median PER dose was 2 mg (range; 2-8 mg). No patients discontinued PER monotherapy owing to adverse effects such as transient dizziness at initial administration.

Conclusion: Perampanel monotherapy was effective for treating a wide spectrum of seizures, especially seizures related to lesions such as brain tumours, stroke and trauma. Seizure control could be achieved with a minimum dose of PER (2 mg/day).