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Perampanel use in pediatric autoimmune encephalitis-related seizures and epilepsy: a retrospective case series
Jiaqin Yi1, Qing Lu1, Ling Hu1
1Department of Neurology, Wuhan Children's Hospital of Tongji Medical College, Wuhan, China.
Insights
Perampanel (PER) showed promise in managing seizures in pediatric patients with autoimmune encephalitis (AE)-related epilepsy. This study found seizure improvement with PER, with no serious adverse events reported in this small case series.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Background:
- Limited data exists on antiseizure medications (ASMs) for autoimmune encephalitis (AE)-related seizures and epilepsy in children.
- Perampanel (PER) has shown potential in managing seizures associated with inflammatory conditions.
Purpose of the Study:
- To evaluate seizure outcomes and tolerability of PER in pediatric patients with AE-related seizures and epilepsy.
Main Methods:
- Retrospective, single-center study of 14 pediatric patients with AE treated with PER (2020-2025).
- Patients were categorized into acute symptomatic seizures secondary to AE (ASSAE) and autoimmune-associated epilepsy (AAE) groups.
- Clinical data, seizure outcomes, and adverse events were collected and analyzed.
Main Results:
- In the ASSAE group, 42.8% of patients achieved seizure resolution.
- In the AAE group, 57.1% achieved ≥50% reduction in seizure frequency, and 42.8% achieved seizure freedom at 3 months.
- No serious adverse events were reported.
Conclusions:
- Perampanel demonstrated potential for seizure improvement in pediatric patients with AE-related seizures or epilepsy.
- Findings are preliminary due to the small sample size and concomitant treatments; further research is warranted.
Objective:
There is limited data regarding the use of antiseizure medications (ASMs) for autoimmune encephalitis (AE)-related seizures and epilepsy, particularly in pediatric patients. Perampanel (PER) was associated with seizure improvement in controlling seizures of inflammatory etiology. The objective of this study was to describe seizure outcomes and tolerability after PER administration in pediatric patients with AE-related seizures and epilepsy.
Methods:
This retrospective, single-center study (2020-2025) reviewed 14 pediatric patients diagnosed with AE who received PER during either the acute symptomatic phase or the chronic phase of autoimmune-associated epilepsy. Clinical data, seizure outcomes, concomitant treatments, and adverse events were retrospectively collected and descriptively analyzed.
Results:
Fourteen pediatric patients with AE (9 male, 5 female; median age 8.5 years) were treated with PER. The median maintenance dose of PER ranged from 2 to 4 mg per day. According to the classification by the International League Against Epilepsy (ILAE), the patients were divided into two groups: (a) acute symptomatic seizures secondary to AE (ASSAE), and (b) autoimmune-associated epilepsy (AAE). In the ASSAE group, 42.8% (3/7) of the patients achieved seizure resolution during the acute phase. In the AAE group, at the 3-month endpoint, 57.1% (4/7) of patients achieved a ≥ 50% reduction in seizure frequency compared to baseline, meeting the responder criteria. Additionally, 42.8% (3/7) of patients in the AAE group achieved seizure freedom at the 3-month endpoint. No serious adverse events were reported in either group.
Conclusion:
In this small retrospective case series, seizure improvement was observed in some pediatric patients with AE-related seizures or epilepsy after PER administration, without serious adverse events. Because most patients received concomitant ASMs and immunotherapy, these findings should be interpreted as preliminary and hypothesis-generating.
Clinical Trial Registration:
https://www.chictr.org.cn/showproj.html?proj=191349, identifier: ChiCTR2300074696.
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