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Updated: Jan 15, 2026

Use of a Wireless Video-EEG System to Monitor Epileptiform Discharges Following Lateral Fluid-Percussion Induced Traumatic Brain Injury
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Use of a Wireless Video-EEG System to Monitor Epileptiform Discharges Following Lateral Fluid-Percussion Induced Traumatic Brain Injury

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Perampanel for Early Seizure Prophylaxis After Severe Traumatic Brain Injury: A Retrospective Comparative Study with

Hidetaka Onda1,2, Takuya Nishino3, Shoji Yokobori2

  • 1Department of Disaster and Emergency Medicine, Kochi University, Nankoku, Japan.

Neurotrauma Reports
|October 15, 2025
PubMed

Insights

Perampanel (PER) significantly reduced early post-traumatic seizures (EPTS) in severe traumatic brain injury (TBI) patients compared to levetiracetam (LEV). PER also shortened mechanical ventilation duration, suggesting its potential as a valuable alternative for seizure prophylaxis.

Area of Science:

  • Neuroscience
  • Trauma Care
  • Pharmacology

Background:

  • Early post-traumatic seizures (EPTS) following severe traumatic brain injury (TBI) are associated with adverse neurological outcomes.
  • Levetiracetam (LEV) is a common choice for seizure prophylaxis, but Perampanel (PER), an AMPA receptor antagonist, shows promise for neuroprotection.

Purpose of the Study:

  • To compare the efficacy of Perampanel (PER) versus Levetiracetam (LEV) in preventing EPTS within 7 days post-severe TBI.
  • To evaluate secondary outcomes including mechanical ventilation duration, hospital stay, and Glasgow Outcome Scale (GOS) scores.

Main Methods:

  • Retrospective cohort study of 200 adult patients with severe TBI receiving either LEV or PER monotherapy within 12 hours of injury.
  • Statistical analyses included Firth's logistic regression and inverse probability of treatment weighting (IPTW) to adjust for confounders.

Main Results:

  • EPTS incidence was significantly lower in the PER group (1.8%) compared to the LEV group (15.9%).
  • PER demonstrated a significant reduction in seizure risk (Firth-adjusted OR = 0.158, p=0.007; IPTW OR = 0.112, p=0.037).
  • PER group showed a shorter mechanical ventilation duration (IRR = 0.515, p=0.015), with no significant differences in GOS or hospital stay. No adverse events were reported.

Conclusions:

  • Perampanel (PER) is more effective than Levetiracetam (LEV) in reducing early post-traumatic seizures (EPTS) in severe TBI patients.
  • PER's efficacy and safety profile suggest it as a potentially valuable alternative for seizure prophylaxis in acute TBI care.
  • Further research into PER's role in TBI management is warranted.

Keywords:
intensive careneuroprotectionpost-traumatic epilepsyprophylactic therapy

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