Journal Article

Efficacy of Perampanel in Refractory and Super-Refractory Status Epilepticus with Suspected Inflammatory Etiology: A Case Series

Nilo, Annacarmen, Vogrig, Alberto, Valente, Mariarosaria, Verriello, Lorenzo, Pauletto, Giada, Belluzzo, Marco, Lettieri, Christian

2023

Overview

(1) Background: Increasing evidence supports the anti-inflammatory and neuroprotective role of perampanel (PER), mediated by decreased expression of pro-inflammatory cytokines and by interference with apoptosis processes. Therefore, the use of PER to treat status epilepticus (SE) with suspected inflammatory etiology is appealing and deserves further investigation. (2) Methods: We retrospectively analyzed seven patients (five F, two M; median age: 62 years) with refractory and super-refractory SE due to a probable or defined inflammatory etiology and treated with PER. (3) Results: PER was administered as the third (4/7) or fourth drug (3/7), with a median loading dose of 32 mg/day (range: 16–36 mg/day) and a median maintenance dose of 10 mg/day (range: 4–12 mg/day). In five cases, SE was focal, while in two patients, it was generalized. SE was caused by systemic inflammation in three patients, while in the other four subjects, it was recognized to have an autoimmune etiology. SE resolution was observed after PER administration in all cases, particularly within 24 h in the majority of patients (4/7, 57.1%). (4) Conclusions: Our data support the efficacy of PER in treating SE when first- and second-line ASMs have failed and suggest a possible earlier use in SE cases that are due to inflammatory/autoimmune etiology.

• Publisher: MDPI AG,MDPI
• Subject: Apoptosis / Causes and theories of causation / Convulsions & seizures / Cytokines / Development and progression / Diseases / Drug dosages / Epilepsy / Etiology / Inflammation / neuroinflammation / Neurophysiology / Patients / Perampanel / retrospective study / Severe acute respiratory syndrome coronavirus 2 / Status epilepticus / treatment