てんかん治療におけるペランパネルの臨床成績と特性に基づく治療選択

Optimal Use of Perampanel in the Treatment of Patients with Epilepsy Based on the Clinical Evidence and Characteristics

ペランパネル（PER）は，てんかん患者の部分発作（焦点発作）に対する単剤・併用療法，強直間代発作（全般強直間代発作）に対する併用療法において，国内外で臨床成績が集積されてきた。それらのエビデンスから，PERが “broad spectrum”（広域スペクトラム）としての特性を備えている可能性が示唆されており，実際にミオクロニー発作などのさまざまなタイプの発作を有する症例において，PERの有効性が報告されている。そこで本論では，PERの最新知見を整理し，そのbroad spectrumとしての特性およびその特性に基づく治療選択について概説するとともに，症例に応じた最適なPER投与法についても言及した。

Abstract

Perampanel (PER) has been used clinically as monotherapy and adjunctive therapy for focal seizures and as adjunctive therapy for generalized tonic-clonic seizures in epilepsy patients in Japan. In recent years in Japan and worldwide, clinical studies have been conducted on patients with various seizure types of epilepsy. The results have shown that PER has broad spectrum properties. The pooled analysis of controlled trials (PERMIT study) showed PER efficacy in patients with status epilepticus, myoclonic seizures, and absence seizures. In addition, PER has been shown to be safe and effective in patients with juvenile myoclonic epilepsy, Lennox-Gastaut syndrome, and elderly-onset epilepsy that are often difficult to treat with narrow-spectrum ASM. In this review article, we summarize the latest findings on PER, and overview the broad spectrum characteristics of PER. In addition, we discuss the optimal use of PER for patients with epilepsy, focusing on low-dose initiation and on slow titration of PER to minimize adverse events.

(Received December 7, 2021; Accepted March 29, 2022; Published July 1, 2022)