Exploring the efficacy and safety of perampanel in epilepsia partialis continua: A case series

BACKGROUND: Epilepsia partialis continua (EPC) is a form of focal motor status epilepticus (SE), which is commonly drug-resistant requiring treatment with multiple antiseizure medications (ASM). There are no established guidelines for pharmacological management. Perampanel (PER), an AMPA receptor antagonist, has gained attention in treating SE based on limited case reports. This study evaluates the efficacy of PER in treating EPC. METHODS: We retrospectively analyzed the treatment response and adverse effects of PER in patients with EPC at our local centre between January 2024 and March 2025. Eight patients with EPC were included. The loading dose of PER ranged from 6 mg to 20 mg. A clinical response was defined as seizure freedom within 72 h of initiating PER, with PER being the last ASM added. RESULTS: PER resulted in seizure termination in eight out of eight patients. Time to response ranged from less than 24 h to 72 h. Oral PER, up to a dose of 16 mg, was well-tolerated in conscious patients. Common side effects included sedation, delirium, agitation, and nausea. CONCLUSIONS: Our real-world data suggest that PER is an effective and well-tolerated early adjunct therapy in EPC, particularly at higher oral loading doses in conscious patients.