Efficacy of perampanel in refractory nonconvulsive status epilepticus and simple partial status epilepticus

Redecker, Juliane; Wittstock, Matthias; Rösche, Johannes

doi:10.1016/j.yebeh.2015.01.036

Cited by 53 publications

(52 citation statements)

References 15 publications

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“…A retrospective study has found that it is effective in patients with refractory nonconvulsive or simple partial SE (Redecker et al, 2015). In contrast, in another study perampanel terminated refractory or super refractory SE only in a small fraction of patients (Rohracher et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Enhanced AMPA receptor-mediated neurotransmission on CA1 pyramidal neurons during status epilepticus

Joshi

Rajasekaran

Sun

et al. 2017

Neurobiology of Disease

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Status epilepticus (SE) is a common neurological emergency that results from the failure of the mechanisms responsible for seizure termination or the initiation of mechanisms that lead to abnormally prolonged seizures. Although the failure of inhibitory mechanisms during SE is well understood, the seizure-initiating mechanisms are poorly understood. We tested whether hippocampal α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR)-mediated transmission was enhanced during SE and assessed the underlying molecular mechanism. In animals in self-sustaining limbic SE the amplitudes of the miniature, spontaneous, and AMPA-evoked excitatory currents recorded from the CA1 pyramidal neurons were larger than those recorded in the controls. The evoked EPSCs rectified inwardly. In these animals, the surface expression of GluA1 subunit-containing AMPARs was increased in the CA1 pyramidal neurons. The phosphorylation of the GluA1 subunit on S831 and S845 residues was reduced in animals in SE. In contrast, the GluA1 subunit surface expression and AMPAR-mediated neurotransmission of dentate granule cells (DGCs) was not altered. Treating animals in SE with the NMDAR antagonist MK-801 or with diazaepam blocked the increased surface expression of the GluA1 subunits. NMDAR blockade also prevented the dephosphorylation of the S845 residue but not that of S831. Targeting NMDARs and AMPARs may provide novel strategies to treat benzodiazepine-refractory SE.

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Section: Discussionmentioning

confidence: 99%

Enhanced AMPA receptor-mediated neurotransmission on CA1 pyramidal neurons during status epilepticus

Joshi

Rajasekaran

Sun

et al. 2017

Neurobiology of Disease

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“…Given the severity of illness and unfavorable outcome in patients with SRSE [44,45], there is a critical need for new therapies to stop ongoing seizure activity. So far, only a few case reports and series have reported on the use of PER in SE [9,46,47].…”

Section: Use In Refractory and Super-refractory Status Epilepticusmentioning

confidence: 99%

“…Treatment of a further nine patients (56% women) with 10 episodes of SE and treatment with PER were reported from Rostock in Germany [46]; one episode of this series was published separately as a case report [47] and PER was given after a median number of six antiepileptic drugs in dosages of 6 mg in most of the cases, and titration to 12 mg in three of ten episodes. Depending on the different efficacy criteria applied, PER was rated as the drug terminating a non-convulsive status epilepticus or simple partial status epilepticus in two to six of 10 episodes.…”

Section: Use In Refractory and Super-refractory Status Epilepticusmentioning

confidence: 99%

Perampanel in the treatment of focal and idiopathic generalized epilepsies and of status epilepticus

Strzelczyk

Willems

Willig

et al. 2015

Expert Review of Clinical Pharmacology

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Perampanel is the latest approved antiepileptic drug in focal and generalized epilepsies and has a distinct and selective mode of action on AMPA-receptors. Several thousand patients have received perampanel within randomized placebo-controlled trials, open-label extension trials and post-marketing observational studies. Significant median partial-onset seizure reduction rates of 23% for 4 mg/day, 26-31% for 8 mg/day and 18-35% for 12 mg/day were reported. Likewise 50 percent responder rates were 29% for 4 mg/day, 33-38% for 8 mg/day and 34-36% for 12 mg/day. Primary generalized tonic-clonic seizures were reduced by 76.5% (8 mg) vs 38.4% (placebo) in a recent controlled trial. Overall, perampanel is well tolerated and the main adverse events are dizziness, somnolence and fatigue. There are also anecdotal reports on use in progressive myoclonic epilepsies and status epilepticus. Perampanel will likely remain an important, possibly broad-spectrum AED with a significant market share, especially in patients with drug-refractory epilepsies.

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“…According to our case reports (this paper, Rösche et al, 2014;Redecker et al, 2015) PER may be an effective treatment option in EPC. This finding should be confirmed by further studies.…”

Section: Discussionmentioning

confidence: 75%

Successful treatment of epilepsia partialis continua due to Rassmussen encephalitis with perampanel

Göde¹,

Großmann²,

Rösche³

2016

Journal of Epileptology

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SUMMARYBackground. Epilepsia partialis continua (EPC) is a difficult to treat condition, which tends to be refractory to antiepileptic drugs (AEDs). We previously published two other treatment episodes of EPC due to stroke and vascular dementia with a possible effect of perampanel (PER). Aim. With the publication of a third treatment episode of EPC terminated by the administration of PER we would like to suggest that PER may be an effective treatment option in this condition. Material and Methods. We present a case where PER was the last AED introduced in the treatment of a patient with EPC and individual seizures due to Rasmussen encephalitis before his seizure frequency could be reduced significantly. Results. A 44 years old male patient, who had been on a combination therapy of at least 4 AEDs since the age of 24, was admitted to our hospital presenting with an EPC. After the introduction of PER in the therapy EPC stopped and he remained seizure free for more than a year. Two of his other AEDs could be tapered of. Conclusion. PER might be especially effective in EPC.

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Efficacy of perampanel in refractory nonconvulsive status epilepticus and simple partial status epilepticus

Cited by 53 publications

References 15 publications

Enhanced AMPA receptor-mediated neurotransmission on CA1 pyramidal neurons during status epilepticus

Enhanced AMPA receptor-mediated neurotransmission on CA1 pyramidal neurons during status epilepticus

Perampanel in the treatment of focal and idiopathic generalized epilepsies and of status epilepticus

Successful treatment of epilepsia partialis continua due to Rassmussen encephalitis with perampanel

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