Perampanel – Psychiatric Side Effects — SCE Neurology MCQ

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ModerateEpilepsy & Seizure DisordersPerampanel – Psychiatric Side EffectsSCE Neurology

A 40-year-old woman with drug-resistant focal epilepsy is prescribed perampanel as adjunctive therapy. Her neurologist warns about specific behavioural side effects. What is the most important psychiatric adverse effect associated with perampanel?

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Correct answer: B — Aggression, hostility, and irritability

Perampanel (a selective non-competitive AMPA receptor antagonist) is associated with psychiatric adverse effects, most notably aggression, hostility, and irritability, occurring in approximately 5–12% of patients. These effects are dose-related and more common at higher doses (≥8 mg/day). Patients and carers should be counselled about these risks before starting treatment. A: Depression can occur but aggression is the most characteristic. C: Psychosis is less common. D: Mania is not a primary concern. E: OCD is not associated.

Reference: NICE NG217 (2025); Perampanel SmPC; BNF