Experience of low dose perampanel to add-on in glioma patients with levetiracetam-uncontrollable epilepsy

Masashi Chonan, Ryuta Saito, Masayuki Kanamori, Shin Ichiro Osawa, Mika Watanabe, Hiroyoshi Suzuki, Nobukazu Nakasato, Teiji Tominaga

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


After introduction of levetiracetam (LEV), treatment of seizures in patients with malignant brain tumors has prominently improved. On the other hand, we still experience some cases with LEV-uncontrollable epilepsy. Perampanel (PER) is a noncompetitive a-amino-3-hydroxy-5-methyl-4-isoaxazolepropionate acid receptor antagonist that has recently been approved for treating focal epilepsy as a secondary drug of choice. Available literature reporting PER medication in patients with gliomas is still sparse. Here, we report our initial experience with glioma patients and report efficacy of adding low dose 2–4 mg PER to LEV in patients whose seizure were uncontrollable with LEV monotherapy. Clinical outcome data of 18 consecutive patients were reviewed. This included nine males and nine females aged 24–76 years (median, 48.5 years), treated for glioma between June 2009 to December 2018. We added PER to patients with LEV-uncontrollable epilepsy. Adverse effects, irritability occurred in two patients, but continuous administration was possible in all cases. Though epileptic seizures occurred in four cases receiving 2 mg PER, 17 cases achieved seizure freedom by dose increments; final dose, 2–4 mg PER added to LEV 500–3000 mg. Our study revealed anti-epileptic efficacy of low dose PER 2–4 mg as first add-on therapy to LEV in glioma patients who have failed or intolerable to LEV monotherapy. Low dose PER added on to LEV may have favorable efficacy with tolerable adverse effects in glioma patients with LEV-uncontrollable epilepsy.

Original languageEnglish
Pages (from-to)37-44
Number of pages8
JournalNeurologia medico-chirurgica
Issue number1
Publication statusPublished - 2020


  • Epilepsy
  • Glioma
  • Levetiracetam
  • Perampanel

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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