Abstract
Background/Objective
Perampanel is a novel anti-epileptic drug (AED) which acts as a non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist to reduce glutamate-mediated postsynaptic excitation. Previous animal studies and a few case reports/series have suggested that it may be effective to treat refractory status epilepticus (RSE).
Methods
We retrospectively reviewed 67 consecutive patients with RSE, of whom 22 received perampanel. The clinical features, epidemiology-based mortality score in status epilepticus, status epilepticus severity score, seizure control, functional outcome, RSE etiology, and electroencephalogram findings were collected. Responder to perampanel was defined as seizure resolution within 4 days of therapy with perampanel being the last AED used plus no recurrence during hospitalization.
Results
Eight of the 22 (36.4%) RSE patients fulfilled the definition of responder to perampanel. An additional 1 patient responded to perampanel after 4 days of treatment. In total, perampanel was the last AED in 9 (40.1%) patients. Among the 8 responders to perampanel, 5 had convulsive SE, 1 had non-convulsive SE, and 2 had focal motor SE. The responders accounted for both of the patients with focal motor SE (100%), 5 (33.3%) of the 15 patients with convulsive SE, and 1 (20%) of the 5 patients with non-convulsive SE. The ictal and inter-ictal activities also decreased after perampanel therapy, and three patients (13.6%) had preferable outcomes at last follow-up.
Conclusions
Perampanel may be an effective add-on treatment for RSE even in patients who failed multiple AEDs. Our study suggests that perampanel may be more effective for focal motor SE and convulsive SE than non-convulsive SE. As most previous studies have focused on non-convulsive SE, further studies are warranted to clarify the effectiveness of perampanel for different subtypes of SE.
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Funding
The study was supported by grants from Chang Gung Medical Foundation (CMRPG8F0701, CMRPG8G0252) and the Ministry of Science and Technology, Taiwan (MOST107-2314-B-182A-057-MY3), to MHT.
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CJH, CHL, YTL, FYS, CWH, WCT, and MHT contributed to the acquisition and interpretation of the data and revising the manuscript for intellectual content. CJH and MHT contributed to the design and conceptualization of the study; analysis and interpretation of the data; drafting, revising, and final approval of the manuscript for intellectual content. This manuscript has not been published elsewhere and is not under consideration by another journal.
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The authors confirm that they have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. This study was approved by the local human research ethics committees (Chang Gung Medical Foundation Institutional Reviewer Board 103-3665B and 201800677B0).
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Ho, CJ., Lin, CH., Lu, YT. et al. Perampanel Treatment for Refractory Status Epilepticus in a Neurological Intensive Care Unit. Neurocrit Care 31, 24–29 (2019). https://doi.org/10.1007/s12028-019-00704-9
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DOI: https://doi.org/10.1007/s12028-019-00704-9