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Efficacy of Perampanel in Refractory and Super-Refractory Status Epilepticus with Suspected Inflammatory Etiology: A
Annacarmen Nilo1,2, Alberto Vogrig1,2, Marco Belluzzo3
1Clinical Neurology Unit, Department of Head, Neck and Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy.
Abstract:
(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.
Insights
Perampanel effectively treated refractory status epilepticus (SE) in patients with inflammatory or autoimmune causes when other drugs failed. This suggests perampanel may be a valuable treatment option for these specific SE types.
Area of Science:
- Neurology
- Pharmacology
- Inflammation Research
Background:
- Perampanel (PER) exhibits anti-inflammatory and neuroprotective properties by reducing pro-inflammatory cytokines and apoptosis.
- Its potential in treating status epilepticus (SE) with inflammatory origins warrants further investigation.
Purpose of the Study:
- To evaluate the efficacy of perampanel in patients with refractory and super-refractory status epilepticus of inflammatory or autoimmune etiology.
Main Methods:
- Retrospective analysis of seven patients with refractory/super-refractory SE treated with perampanel.
- Patients had SE due to probable or defined inflammatory or autoimmune causes.
- Perampanel was administered as a third or fourth-line treatment.
Main Results:
- All seven patients achieved SE resolution after perampanel administration.
- The majority (57.1%) experienced resolution within 24 hours.
- SE was focal in five patients and generalized in two, with causes including systemic inflammation and autoimmune conditions.
Conclusions:
- Perampanel demonstrates efficacy in treating SE refractory to first- and second-line anti-seizure medications.
- Results suggest considering perampanel earlier in SE cases with inflammatory or autoimmune etiologies.
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