%0 Journal Article
%T Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements.
%A Bonanni P
%A Gambardella A
%A Tinuper P
%A Acone B
%A Perucca E
%A Coppola G
%J BMC Neurol
%V 21
%N 1
%D Oct 2021 26
%M 34702211
%F 2.903
%R 10.1186/s12883-021-02450-y
%X <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.