Perampanel for Refractory Status Epilepticus… Another Tool in the Armamentarium

Excerpt

Despite a dramatic increase in research over the past decade, patients with refractory status epilepticus (RSE) continue to have high mortality and survivors experience significant disability. RSE is defined as status epilepticus which continues despite treatment with a benzodiazepine and a second antiseizure drug (ASD). Its treatment remains a relatively ‘evidence-free zone,’ and is frequently difficult to abort, making any additional treatment options relevant and potentially important. In this issue of Neurocritical Care, Ho et al. [1] reported a retrospective analysis of 67 consecutive patients with RSE, 22 of whom were treated with perampanel. Perampanel, a novel ASD, acts as a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist, and has the effect of reducing glutamate-mediated postsynaptic excitation. In animal models, perampanel has been shown to successfully terminate benzodiazepine RSE when GABAergic inhibition decreases and the ratio of AMPA receptor subunits changes [2, 3]. Recent case series have reported on a total of 41 patients treated with perampanel for predominantly nonconvulsive or focal motor RSE; however, they used variable criteria to define drug responders and reported conflicting results [4‐6]. …