Abstracts

Rationale: Case study on the use of perampanel to treat GBM related epilepsia partialis continua. Methods: Case study Results: A 67 year old male with glioblastoma multiforme s/p resection, chemo, radiation and ongoing Avastin infusions who had a history of focal onset seizures associated with the tumor, with semiology of left face/arm/leg twitching.  He was on levetiracetam, dilantin and phenobarbital at home, the addition of phenobarbital controlled his seizures for a few months initially.  He presented to the hospital with myoclonic jerks of the left face/arm/leg every 10 seconds for the prior 24 hours making eating and talking difficult despite therapeutic levels of AEDs.  The family was not interested in intubation to control the seizures.  EEG showed the myoclonus correlated with discharges in the right parietal region consistent with the location of the residual tumor.  High dose steroids were initiated as were scheduled high dose benzodiazepines while continuing his home AEDs (clobazam and then also scheduled clonazepam). After 5 days this did initially reduce the seizures but he became so lethargic that he could not take nutrition or interact with family and he continued to have bursts of seizure activity a few times a day. The decision was made to trial a rapid up titration of perampanel given the reported increase in glutamate production around GBM tumors.  This was done over 3 days to a target does of 10mg daily.  This was concomitant with weaning off clobazam and all benzo.  By day 4 he was seizure free, awake, oriented, interacting with family and eating.  He was able to go home and spend the remaining months of his life with his family seizure free.   Conclusions: This case supports the use of perampanel to treat epilepsy related to glial tumors and the superior mental status obtained with seizure suppression compared to conventional treatment options.   Funding: No outside funding.