Epilepsy is one of the most common chronic nervous system diseases around the world. Up to now， pharmacotherapy remains the cornerstone treatment of patients with epilepsy among all antiepileptic therapies. There are currently more than 20 antiepileptic drugs available to clinicians， but only 70% of the patients with epilepsy can be treated by antiepileptic drugs to achieve adequate control of epileptic seizure. Perampanel （PER）， as the third-generation antiepileptic drug， has a new mechanism of action and excellent pharmacokinetics and has been launched and put into clinical use in many countries. At present， PER is mainly used in the add-on therapy for patients with epilepsy and has achieved good efficacy， while further studies are needed to explore the application prospect of PER in monotherapy. This article reviews the characteristics， clinical efficacy， and adverse reactions of PER and summarizes the clinical trials and real-world application of PER as add-on therapy and monotherapy， in order to provide a theoretical basis for clinical application. ［Journal of International Neurology and Neurosurgery, 2022, 49(6): 70-76］