Perampanel in the treatment of focal epilepsies associated with brain tumors

Epilepsy associated with brain tumors occupies a special place among structural focal epilepsies; it requires a multidisciplinary approach to treatment and close collaboration between a neurologist-epileptologist, a neurosurgeon and an oncologist. Frequent and severe epileptic seizures (including status epilepticus), drug-resistant disease and high mortality rates determine the severity of the condition and the poor quality of life experienced by patients. With the emergence of new and cutting-edge anti-seizure medications (ASMs), it is now a priority to identify the most effective and safest ASMs for the treatment of this patient group. Objective: a retrospective comparative analysis of the efficacy and tolerability of perampanel (PER) as an adjunctive therapy for tumor-associated epilepsies, compared with conventional antiepileptic drugs (AEDs). Material and methods. The study included data from 156 adult patients (aged 19–83) with primary and secondary brain tumors and tumor-associated epilepsy. The patients were divided into two comparable groups of 78 patients each: the main group received antiepileptic therapy including PER, whilst the comparison group received combinations of other AEDs. The follow-up period ranged from 1 year to 3 years or more. Efficacy was assessed after 12 months of treatment in both groups. Results. In the main group, 59% of patients achieved either a one-year seizure remission or a reduction in their frequency of more than 50%, which was significantly higher than the corresponding figure in the comparison group (41%; p=0.014). The incidence of adverse events in the PER group was half that in the control group (10% versus 20%); these events were dose-dependent and did not require discontinuation of the drug. Conclusion. PER has demonstrated high efficacy and a favourable safety profile in tumor-associated epilepsy, which justifies its use in clinical practice for this patient group.