Efficacy and safety of perampanel in critically ill pediatric patients with refractory and super‐refractory status epilepticus: a retrospective study from a Chinese tertiary medical center

Abstract

Objective

Status epilepticus (SE) is a life-threatening neurological emergency in critically ill children. Limited data exist regarding the use of perampanel for benzodiazepine-resistant SE in this population. This study was conducted to evaluate the effectiveness and safety of perampanel in Chinese critically ill children and adolescents with SE.

Methods

This retrospective observational study was conducted from March 2020 to March 2025 at a tertiary hospital in China. Efficacy was defined as seizure cessation within 72 h of perampanel administration, confirmed by clinical and continuous video electroencephalograph monitoring. Adverse effects were defined using predefined criteria, primarily within 7 days post-administration.

Results

Of 237 pediatric patients identified as experiencing SE, 32 (13.5 %) received perampanel, including 15 females with median age 12.0 years (range, 4.3–17.0 years; IQR, 8.8–16.0 years). The overall response rate was 40.6 %, highest in the focal motor SE group (8/12, 66.7 %) compared to the generalized tonic-clonic seizures (3/10, 30.0 %) and nonconvulsive status epilepticus groups (2/10, 20.0 %). Non-responders had a higher maximal perampanel dose compared to responders. Among responders, those receiving concomitant midazolam required a lower dose versus those without midazolam. No significant liver enzyme elevation was noted pre- and post- perampanel administration.

Significance

Our data support the efficacy of perampanel in treating refractory-SE and super-refractory SE in critically ill pediatric patients and variability in treatment response based on the different subtypes of SE. Combination therapy with midazolam might reduce the perampanel dose required to achieve seizure cessation. However, further studies are warranted in a larger patient population.