Purpose: To systematically review the evidence on efficacy and safety of Perampanel in children and adolescent.

Method: Literature search was performed in Google scholar and PUBMED with keywords –Perampanel, children, refractory epilepsy and the text word Perampanel. Eight Papers published between 2010-2018, reporting use of Perampanel in children less and adolescents with refractory epilepsy were analyzed. It included 3 Retrospective, 4 Randomized control trials (RCT) ,one study with retrospective and prospective analysis. The outcome measures used were the percentage of patients with complete elimination of seizures, >50%reduction in seizures, <50% reduction in seizures. Deaths and common adverse events were noted.

Results: The cumulative sample size was 591 children with predominant focal drug refractory Epilepsy.  Median age of enrollment of cases was 12 years. Perampanel was given in low dose (2 mg/d) in 4.02 % cases and high dose (8-12mg/d) in 36.39 % cases. Common adjuvant drugs were valproic acid levetiracetam, carbamazepine, and oxcarbazepine. Mean duration of the therapy was 20 weeks. Complete cessation of seizures was mentioned in 3 RCT in 12.75 % cases. More than 50% reduction was observed in 34.80 % cases while no improvement was seen in 3.48%. Adverse events like dizziness (22%) and somnolence (12.78%) and behavioral aggression were commonly observed during therapy. None of the studies reported death while on therapy. Discontinuation of therapy due to various reasons was observed in 30.70%.

Conclusion: Perampanel can be safe and promising in seizure remission in refractory focal seizures in children, in escalating doses.