Combining perampanel and ketamine in super refractory post-traumatic status epilepticus: A case report

Manganotti, Paolo; Cheli, Marta; Dinoto, Alessandro; Biaduzzini, Francesco; Tomaselli, M.; Mazzon, Giulia; Roman-Pognuz, Erik; Meletti, Stefano

doi:10.1016/j.seizure.2021.04.026

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…The male to female case ratio was 196:144. For convenience, we have categorized the included studies into larger case series ( N = 42–68) [ 13 – 16 ], smaller case series ( N = 5–20) [ 17 – 24 ], and case reports ( N = 1–3) [ 25 – 31 ] (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Wang et al reported a difference in resolution rates between two groups i.e., 100% in the group receiving both loading and maintenance dose and 36.4% in group receiving only maintenance dose. Duration of ketamine infusion resulting into seizure resolution was mentioned only in two smaller case series and four case reports, which varied from 1 day to 28 days [ 17 , 19 , 25 , 26 , 28 , 31 ] (Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

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Use of ketamine in Super Refractory Status Epilepticus: a systematic review

Adhikari,

Yadav,

Nepal

et al. 2024

Neurol. Res. Pract.

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Objective This review specifically investigates ketamine’s role in SRSE management. Methods PubMed, EMBASE, and Google Scholar databases were searched from inception to May 1st, 2023, for English-language literature. Inclusion criteria encompassed studies on SRSE in humans of all ages and genders treated with ketamine. Results In this systematic review encompassing 19 studies with 336 participants, age ranged from 9 months to 86 years. Infections, anoxia, and metabolic issues emerged as the common causes of SRSE, while some cases had unknown origins, termed as NORSE (New Onset RSE) or FIRESs (Febrile Infection-Related Epilepsy Syndrome). Most studies categorized SRSE cases into convulsive (N = 105) and non-convulsive (N = 197). Ketamine was used after failed antiepileptics and anesthetics in 17 studies, while in others, it was a first or second line of treatment. Dosages varied from 0.5 mg/kg (bolus) and 0.2-15 mg/kg/hour (maintenance) in adults and 1-3 mg/kg (bolus) and 0.5-3 mg/kg/hour (maintenance) in pediatrics, lasting one to 30 days. Ketamine was concurrently used with other drugs in 40–100% of cases, most frequently propofol and midazolam. Seizure resolution rate varied from 53.3 to 91% and 40–100% in larger (N = 42–68) and smaller case series (N = 5–20) respectively. Seizure resolution occurred in every case of case report except in one in which the patient died. Burst suppression in EEG was reported in 12 patients from two case series and two case reports. Recurrence was reported in 11 patients from five studies. The reported all-cause mortality varied from 38.8 to 59.5% and 0-36.4% in larger and smaller case series., unrelated directly to ketamine dosage or duration. Significance Ketamine demonstrates safety and effectiveness in SRSE, offering advantages over GABAergic drugs by acting on NMDA receptors, providing neuroprotection, and reducing vasopressor requirement.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Use of ketamine in Super Refractory Status Epilepticus: a systematic review

Adhikari,

Yadav,

Nepal

et al. 2024

Neurol. Res. Pract.

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Efficacy of perampanel by etiology in Japanese patients with epilepsy—subpopulation analysis of a prospective post‐marketing observational study

Nakai,

Nishimoto,

Higashibeppu

et al. 2024

Epilepsia Open

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ObjectiveTo examine the efficacy and safety of perampanel (PER) in patients with post‐stroke epilepsy (PSE), brain tumor‐related epilepsy (BTRE), and post‐traumatic epilepsy (PTE) using Japanese real‐world data.MethodsThe prospective post‐marketing observational study included patients with focal seizures with or without focal to bilateral tonic–clonic seizures who received PER combination therapy. The observation period was 24 or 52 weeks after the initial PER administration. The safety and efficacy analysis included 3716 and 3272 patients, respectively. This post hoc analysis examined responder rate (50% reduction in seizure frequency), seizure‐free rate (proportion of patients who achieved seizure‐free), and safety in patients included in the post‐marketing study who had PSE, BTRE, and PTE in the 4 weeks prior to the last observation.ResultsOverall, 402, 272, and 186 patients were included in the PSE, BTRE, and PTE subpopulations, and 2867 controls in the “Other” population (etiologies other than PSE, BTRE, or PTE). Mean modal dose (the most frequently administered dose) values at 52 weeks were 3.38, 3.36, 3.64, and 4.04 mg/day for PSE, BTRE, PTE, and “Other,” respectively; PER retention rates were 56.2%, 54.0%, 52.6%, and 59.7%, respectively. Responder rates (% [95% confidence interval]) were 82% (76.3%–86.5%), 78% (70.8%–83.7%), 67% (56.8%–75.6%), and 50% (47.9%–52.7%) for PSE, BTRE, PTE, and “Other,” respectively, and seizure‐free rates were 71% (64.5%–76.5%), 62% (54.1%–69.0%), 50% (40.6%–60.4%), and 28% (25.8%–30.1%), respectively. Adverse drug reactions tended to occur less frequently in the PSE (14.7%), BTRE (16.5%), and PTE (16.7%) subpopulations than in the “Other” population (26.3%).SignificanceIn real‐world clinical conditions, efficacy and tolerability for PER combination therapy were observed at low PER doses for the PSE, BTRE, and PTE subpopulations.Plain Language SummaryTo find out how well the medication perampanel works and whether it is safe for people who have epilepsy after having had a stroke, brain tumor, or head injury, we used information from real‐life medical situations in Japan. We looked at the data of about 3700 Japanese patients with epilepsy who were treated with perampanel. We found that perampanel was used at lower doses and better at controlling seizures, and had fewer side effects for patients with epilepsy caused by these etiologies than the control group.

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Midazolam/propofol/valproic acid

2021

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Combining perampanel and ketamine in super refractory post-traumatic status epilepticus: A case report

Cited by 5 publications

References 4 publications

Use of ketamine in Super Refractory Status Epilepticus: a systematic review

Use of ketamine in Super Refractory Status Epilepticus: a systematic review

Efficacy of perampanel by etiology in Japanese patients with epilepsy—subpopulation analysis of a prospective post‐marketing observational study

Midazolam/propofol/valproic acid

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