Optimal Use of Perampanel in Elderly Asian Patients with Epilepsy: Expert Opinion

Chin-Wei Huang,1 Kanokwan Boonyapisit,2 Suryani Gunadharma,3 Josephine Casanova-Gutierrez,4,5 Liri Jin,6 Dinesh Nayak,7 Naoki Akamatsu8,9 1Division of Epileptology, Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Division of Neurology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand; 3Department of Neurology, Faculty of Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia; 4Department of Internal Medicine, Section of Neurology, De La Salle University Medical Center and College of Medicine, Dasmariñas, Philippines; 5Department of Neurosciences, University of the Philippines College of Medicine–Philippine General Hospital, Manila, Philippines; 6Department of Neurology, Peking Union Medical College Hospital, Beijing, People’s Republic of China; 7Department of Neurology, Gleneagles Global Health City, Chennai, India; 8Department of Neurology, International University of Health and Welfare, Narita, Japan; 9Epilepsy and Sleep Disorders Center, Fukuoka Sanno Hospital, Fukuoka, JapanCorrespondence: Naoki Akamatsu, Epilepsy and Sleep Disorders Center, Fukuoka Sanno Hospital, 3-6-45 Momochi-hama, Sawara-ku, Fukuoka, 814-0001, Japan, Tel +81 092-832-1100, Fax +81 092-832-3061, Email akamatsu@iuhw.ac.jpAbstract: Managing epilepsy in the elderly remains complicated largely due to factors related to aging. In this population, management practices are increasingly shifting towards the use of newer-generation anti-seizure medications (ASMs) as they are generally associated with better tolerability and safety profiles than older ones. Perampanel is a new ASM with broad-spectrum efficacy and a favorable safety profile. However, because of the lack of information and experience in its use, the prescription of perampanel has not been optimized in the elderly in the real-world setting in Asia. A group of epilepsy experts across the region convened at a series of virtual meetings to share their experience and discuss recommendations on perampanel use in elderly patients, including dose optimization, considerations with treatment initiation, and strategies to manage adverse events and maximize tolerability. This article summarizes key clinical and real-world evidence for perampanel in the elderly and consolidates the experts’ opinions on optimizing perampanel use in elderly Asian patients with epilepsy, providing practical guidance for clinicians to address challenges related to treatment initiation and tolerance.Keywords: perampanel, elderly, epilepsy, real-world experience, Asia