Objective: To assess the effectiveness and tolerability of perampanel (PER) monotherapy in routine clinical practice for the treatment of focal onset and generalized tonic-clonic seizures (GTCS). Methods: This multicenter, retrospective, observational study was conducted in patients aged ≥12 years treated with PER as primary monotherapy or converted to PER monotherapy by progressive reduction of background antiepileptic drugs. Outcomes included retention, responder, and seizure-free rate after 3, 6, and 12 months and tolerability throughout the follow-up. Results: A total of 98 patients (mean age = 49.6 ± 21.7 years, 51% female) with focal seizures and/or GTCS were treated with PER monotherapy for a median exposure of How to cite this article: Toledano DelgadoR, García-Morales I, Parejo-Carbonell B, et al. Effectiveness and safety of perampanel monotherapy for focal and generalized tonic-clonic seizures: Experience from a national multicenter registry.

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A one-year prospective, observational study was conducted in 222 elderly patients (>65 years old) with epilepsy. Patients received 25 mg/day lamotrigine for the first 15 days. The dose was then increased to 50 mg/day; further increases were allowed if necessary. Vascular epilepsy was the most frequent diagnosis (56% of patients), and concomitant medication was required by 75% of patients. The mean dose was 72.17 mg/day in the 132 patients who completed the study; the initial dose of 50 mg/day was maintained in 52% of these patients. There was a marked reduction in the number of seizures with 89% of the patients who completed the study continuing to be seizure-free after 1 year. Tolerability was generally good with 15 adverse events in nine patients. Only two patients developed a rash. In conclusion, low-dose lamotrigine is an effective and well tolerated therapy for the control of epilepsy in elderly patients.

Categorising psychotic states associated with epilepsy according to their temporal relationship with seizures is clinically and prognostically useful because it provides important information regarding disease treatment and progression. The treatment of peri-ictal or acute mental disorders is based on epileptic seizure control, while the treatment of interictal or chronic disorders has more in common with managing disorders which are purely psychiatric in origin. In addition to improving the patient's quality of life and reducing disability, achieving strict control over seizures may also prevent the development of interictal psychosis. For this reason, we believe that establishing a treatment protocol for such cases is necessary.

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