Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements
Abstract Background 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 stu...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-021-02450-y |
| _version_ | 1818987365458247680 |
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| author | Paolo Bonanni Antonio Gambardella Paolo Tinuper Benedetto Acone Emilio Perucca Giangennaro Coppola |
| author_facet | Paolo Bonanni Antonio Gambardella Paolo Tinuper Benedetto Acone Emilio Perucca Giangennaro Coppola |
| author_sort | Paolo Bonanni |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusion 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. |
| first_indexed | 2024-12-20T19:05:32Z |
| format | Article |
| id | doaj.art-2cbafb2bcfbf4f34aa4e7c5484de4c8f |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-12-20T19:05:32Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-2cbafb2bcfbf4f34aa4e7c5484de4c8f2022-12-21T19:29:17ZengBMCBMC Neurology1471-23772021-10-012111810.1186/s12883-021-02450-yPerampanel as first add-on antiseizure medication: Italian consensus clinical practice statementsPaolo Bonanni0Antonio Gambardella1Paolo Tinuper2Benedetto Acone3Emilio Perucca4Giangennaro Coppola5IRCCS Eugenio Medea Scientific Institute, Epilepsy Unit, ConeglianoInstitute of Neurology, University Magna GraeciaIRCCS Istituto delle Scienze Neurologiche di BolognaCartesio solutions s.r.lDivision of Clinical and Experimental Pharmacology, Department of Internal Medicine and Therapeutics, University of PaviaDepartment of Medicine, Surgery, Odontoiatry, Medical School of Salerno, University of SalernoAbstract Background 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. Methods 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. Results 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. Conclusion 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.https://doi.org/10.1186/s12883-021-02450-yPerampanelEpilepsyDelphi procedureAntiepileptic drugsAdjunctive therapy |
| spellingShingle | Paolo Bonanni Antonio Gambardella Paolo Tinuper Benedetto Acone Emilio Perucca Giangennaro Coppola Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements BMC Neurology Perampanel Epilepsy Delphi procedure Antiepileptic drugs Adjunctive therapy |
| title | Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements |
| title_full | Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements |
| title_fullStr | Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements |
| title_full_unstemmed | Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements |
| title_short | Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements |
| title_sort | perampanel as first add on antiseizure medication italian consensus clinical practice statements |
| topic | Perampanel Epilepsy Delphi procedure Antiepileptic drugs Adjunctive therapy |
| url | https://doi.org/10.1186/s12883-021-02450-y |
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