Abstract Details

Title Perampanel Utilization in Management of Status Epilepticus in the Neuro-ICU: A Single-center Retrospective Experience

Topic Neuro Trauma and Critical Care

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 18-002

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.

Authors/Disclosures
Ahmed M. Yassin, MD (Jordan University of Science and Technology) PRESENTER	Dr. Yassin has nothing to disclose.
Suhaib Alquraan, MD	Dr. Alquraan has nothing to disclose.
Shoroq N. Manasreh, MD	Dr. Manasreh has nothing to disclose.
Hanan W. MAHDAWI, MD	Dr. MAHDAWI has nothing to disclose.
Lina M. Al Omari, MD	Dr. Al omari has nothing to disclose.
Hiba Kazakzeh, MD	Dr. Kazakzeh has nothing to disclose.
Al-Zahraa Khalayleh, MD	Dr. Khalayleh has nothing to disclose.
Yaqoot Taani, MD	Dr. Taani has nothing to disclose.
Moayad Al Jezawi	Dr. Al Jezawi has nothing to disclose.
Mohammad M. Dabous, MD	Dr. Dabous has nothing to disclose.
Khalid I. El-Salem, MD, FAAN (Jordan University of Science and Technology)	Dr. El-Salem has nothing to disclose.
Salma Bashayreh, MD (Jordan University of Science and Technology)	Dr. Bashayreh has nothing to disclose.

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