Perampanel Utilization in Management of Status Epilepticus in the Neuro-ICU: A Single-center Retrospective Experience
Ahmed Yassin1, Suhaib Alquraan2, Shoroq Mansara1, Hanan Mahdawi1, Lina Alomari2, Hiba Kazakzeh2, Al-Zahraa Khalayleh2, Yaqoot Ta’ani2, Moayad Al Jezawi2, Mohammad Dabous2, Khalid El-Salem1, Salma Bashayreh1
1Department of Neurology, Jordan University of Science and Technology, 2Faculty of Medicine, Jordan University of Science and Technology
Objective:
To describe perampanel’s indications, dosing, response, and outcomes in treatment of SE in a tertiary hospital’s ICU.
Background:
Perampanel is increasingly used in the treatment of status epilepticus (SE) in the ICU, but real-world data is scarce.
Design/Methods:
We performed a retrospective review of patients who received perampanel for treatment of SE in the neuro-ICU during 2019–2024. Primary outcomes included SE termination following intubation, controlling seizures or improving EEG following cessation of SE, facilitating weaning off anesthetics, and avoiding intubation/anesthetics in non-generalized SE.
Results:
37 patients with SE (35.1% male, median age 66 years) were included. Most had brain insult (83.8%), were intubated (86.5%), and septic (91.9%). A median of 3 anti-seizure medicantions (ASMs) were used before perampanel. Indications and success rates were as follows:
* Terminating SE following intubation: 7/37 (18.9%); termination 2/7 (28.6%).
* Add-on to control seizures/improve EEG after SE cessation: 28/37 (75.7%); success 27/28 (96.4%).
* Facilitating weaning off anesthetics: 8/37 (21.6%); response 4/8 (50%).
* Avoiding anesthetics in non-convulsive SE: 2/37 (5.4%); success 0/2 (neither was the sole indication).
Generally, the last effective perampanel dose for achieving a response was most commonly 12 mg/day (35.1%). Time to response was <48 hours in 54.1% and ≤1 week in 67.6%. In-hospital mortality was high (28/37; 75.7%), reflecting the high mortality of refractory and super-refractory SE and the severity of underlying and comorbid conditions.
Conclusions:
In refractory and super-refractory SE, perampanel was found to play one or more significant roles; it was highly effective as add-on therapy, had moderate but practically useful utility in weaning off anesthetics, showed some effectiveness in late SE termination, but was unsuccessful in preventing intubation in the two cases of non-convulsive SE. These data highlight the need for prospective studies on larger number of patients to define optimal clinical indications, timing, and dosing.
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