Perspective on the use of perampanel and intravenous carbamazepine for generalized seizures.
BACKGROUND
Several antiepileptic drugs are available for the treatment of epileptic patients. However, the treatment of some seizure types and novel drug formulations deserve further advances in epilepsy research.


METHODS
The authors analyze the published evidence on the efficacy of perampanel against secondarily generalized seizures (SGS) and report the currently available development of intravenous (IV) formulations of carbamazepine (CBZ), commenting on their potential in the clinical setting.


CONCLUSIONS
Perampanel is the first noncompetitive AMPA receptor antagonist to be approved as adjunctive treatment in patients with partial-onset (focal) seizures (POS) with or without secondary generalization. Apart from its efficacy and safety on POS, a consistent body of evidence supports its efficacy in SGS at a minimum dose of 8 mg/day; however, such dose appears close to the best-tolerated dose. CBZ is a poorly water-soluble compound; many efforts to develop a parenteral formulation have not been successful so far. Novel IV CBZ formulations seem to exhibit favorable pharmacokinetics along with good tolerability in animal models and in patients taking oral CBZ. Further studies are needed to assess whether larger doses will be as well tolerated, allowing IV CBZ to be used as bridge therapy when the oral route is not feasible or in patients naïve to CBZ.
University of Pavia, Department of Internal Medicine and Therapeutics, Clinical Pharmacology Unit , Pavia , Italy.
Valentina
V
Franco
Alfonso
A
Iudice
Elisabetta
E
Grillo
Rita
R
Citraro
Giovambattista
G
De Sarro
Emilio
E
Russo
D000818:Animals; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D002220:Carbamazepine / Q000008:administration & dosage / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D004829:Epilepsy, Generalized / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D009570:Nitriles; D011728:Pyridones / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012640:Seizures / Q000188:drug therapy*; D016896:Treatment Outcome
D000927:Anticonvulsants; D009570:Nitriles; D011728:Pyridones; D002220:Carbamazepine; C551441:perampanel