Prolonged and severe CNS depression and truncal ataxia in an accidental pediatric perampanel ingestion
Dean DJ, and Schoenling A. Prolonged and severe CNS depression and truncal ataxia in an accidental pediatric perampanel ingestion. Journal of Medical Toxicology 2020; 16(2):124.
Journal of Medical Toxicology
Background: Perampanel exerts antiepileptic effects by reducing neuronal excitation via noncompetitive antagonism of the postsynaptic ionotropic-AMPA-glutamate receptors. Clinical effects in overdose are limited and only mild effects have been reported in adults. Methods: This is a single patient chart review. Results: A previously healthy 2-year-old 15-kg female presented after witnessed ingestion of 30mg of perampanel (2mg/kg).Within 10 minutes of ingestion, the child became ataxic and was unable to walk. She presented to the ED, 30 minutes post-ingestion and had normal VS but was minimally responsive. She was emergently intubated due to profound CNS depression. After transfer to a tertiary care facility, vitals were as follows: 36.5 °C, HR 117, BP 113/73, RR 20(vent), and 100% on 40% FiO2. She required no sedation and ABG showed 7.24/56/65. Serum laboratory results were otherwise unremarkable. UDS immunoassay and GC-MS were both negative. She remained hemodynamically stable and remained intubated for 72 hours with gradual improvement in mental status. After extubation, patient still exhibited truncal ataxia and did not return to her neurologic baseline until 96 hours post-ingestion. Serum perampanel level was 870 ng/mL (ref < 20 ng/mL). Discussion: To date, there are no reported pediatric ingestions of perampanel. Adult toxicity describes mild neurologic symptoms. In this case, our patient exhibited profound CNS depression requiring mechanical ventilation for a prolonged period. At this time, we suggest all pediatric exposures be referred to the ED. Conclusion: This is the first reported confirmed case of perampanel overdose in a child. Pediatric toxicity may result in profound CNS depression requiring prolonged mechanical ventilatory support.