Infection-Induced Elevated Plasma Perampanel in a Patient with Hemimegalencephaly

Figure 2

Clinical course. The patient’s fever resolved immediately after hospitalization but with persistence of the state of impaired consciousness. Perampanel concentration was elevated at the time of admission (1,300 ng/ml) and ultimately increasing to a maximum of 1,790 ng/ml. Cessation of perampanel treatment improved the level of consciousness. Seizures increased with decreasing plasma concentration of perampanel. Fosphenytoin was initially introduced for seizure control, which was then switched to oral carbamazepine. The patient was discharged without apparent sequelae. VPA, valproic acid; CLB, clobazam; LCM, lacosamide; PER, perampanel; CBZ, carbamazepine.