Efficacy and Safety of Perampanel in Patients With Brain Tumor-Related Epilepsy

PURPOSE OF REVIEW: Epileptic seizures are a common and often debilitating complication in patients with brain tumors, significantly affecting quality of life and clinical outcomes. Brain tumor-related epilepsy (BTRE) is characterized by complex pathophysiologic mechanisms, notably glutamate-mediated neuronal hyperexcitability within the peritumoral environment. Perampanel, a selective, noncompetitive antagonist of the AMPA glutamate receptor, represents a mechanistically targeted antiseizure medication that may be particularly suited to this context. This review aims to systematically evaluate and synthesize the available evidence regarding the efficacy and safety of perampanel in patients with BTRE, focusing on seizure control, oncologic outcomes, and tolerability in real-world clinical settings. RECENT FINDINGS: A systematic search of PubMed, Embase, and Cochrane Library identified 8 observational studies involving a total of 382 patients with brain tumors and associated seizures treated with perampanel. Across studies, 57.0% of patients were male, and the mean participant age ranged from 43 to 58 years. Pooled analyses demonstrated that 42% (95% CI 27%-59%) of patients achieved seizure freedom, while 46% (95% CI 31%-61%) experienced a ≥50% reduction in seizure frequency. Oncological progression was reported in 39% (95% CI 17%-65%) of patients, with no evidence of perampanel effect on tumor behavior. Adverse events occurred in 26% (95% CI 17%-38%) of patients, most of which were mild to moderate and consistent with the known safety profile of perampanel. SUMMARY: Perampanel is associated with meaningful seizure control in a substantial proportion of patients with brain tumor-related epilepsy, including high rates of seizure freedom and significant seizure reduction. Importantly, its use does not appear to influence oncologic progression nor substantially increase the incidence of adverse events. Although limited by the nonrandomized nature of the available studies, these findings support perampanel as a valuable therapeutic option for symptomatic seizure management in BTRE, with potential utility in both adjunctive treatment strategies and palliative care settings. Further prospective and controlled studies are warranted to better define its optimal role and long-term impact in this complex patient population.