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Prolonged unconsciousness in perampanel overdose.

Guy Parsons^1,2, Jon Bailey³, Frederick Bailey³

¹Critical Care, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK guy.parsons@nhs.net.

BMJ Case Reports

|December 4, 2019

Summary

Perampanel overdose can cause prolonged unconsciousness, even in patients new to the drug. This case highlights the need for critical care admission and intubation for extended recovery.

Keywords:

drugs: CNS (not psychiatric)epilepsy and seizures intensive care mechanical ventilation neurology (drugs and medicines)

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Area of Science:

Neurology
Clinical Pharmacology

Background:

Perampanel is a novel antiepileptic drug targeting glutamate receptors.
Limited clinical data exists regarding perampanel overdose management.
The drug has a long half-life, suggesting potential for prolonged effects.

Observation:

A perampanel-naïve patient experienced 14 days of unconsciousness after a 3.5x maximum daily dose overdose.
The patient required intensive care unit admission with intubation and mechanical ventilation.
Complete neurological recovery was achieved eventually.

Findings:

This case represents the longest documented period of unconsciousness following perampanel overdose with full neurological recovery.
Perampanel overdose may not present with immediate systemic toxicity but can lead to protracted altered consciousness.
Secondary complications requiring prolonged intensive care management are possible.

Implications:

Informs critical care decision-making for perampanel overdose, emphasizing early admission and intubation.
Suggests that prolonged unconsciousness is a key feature of perampanel overdose, even in treatment-naïve individuals.
Highlights the importance of intensive monitoring and management in severe perampanel overdose cases.