Abstract Background Epilepsia partialis continua (EPC) is a form of focal motor status epilepticus (SE), which is commonly drug‐resistant requiring treatment with multiple antiseizure medications (ASM). There are no established guidelines for pharmacological management. Perampanel (PER), an AMPA receptor antagonist, has gained attention in treating SE based on limited case reports. This study evaluates the efficacy of PER in treating EPC. Methods We retrospectively analyzed the treatment response and adverse effects of PER in patients with EPC at our local centre between January 2024 and March 2025. Eight patients with EPC were included. The loading dose of PER ranged from 6 mg to 20 mg. A clinical response was defined as seizure freedom within 72 h of initiating PER, with PER being the last ASM added. Results PER resulted in seizure termination in eight out of eight patients. Time to response ranged from less than 24 h to 72 h. Oral PER, up to a dose of 16 mg, was well‐tolerated in conscious patients. Common side effects included sedation, delirium, agitation, and nausea. Conclusions Our real‐world data suggest that PER is an effective and well‐tolerated early adjunct therapy in EPC, particularly at higher oral loading doses in conscious patients.
Abstract Background Meteorological conditions have been investigated as potential short‐term correlates of epileptic seizures, but findings remain inconsistent. This study examined whether daily meteorological variation was associated with population‐level online information‐seeking for epilepsy. Methods A daily time‐series study was conducted in Lombardy, Italy, from September 1, 2021, to September 2, 2026. The primary outcome was a reconstructed daily Google Trends series for the Topic Epilessia (epilepsy). Daily mean sea‐level pressure and 2‐m temperature derived from ERA5 were the primary exposures. Distributed lag nonlinear models evaluated cumulative associations over lags 0–7 days, adjusting for long‐term and seasonal trends, day of week, and national holidays. Newey‐West standard errors accounted for residual autocorrelation. Results Among 1822 days with complete exposure histories, lower mean sea‐level pressure (5th percentile, 1003.5 hPa) versus the median (1016.8 hPa) was associated with higher cumulative epilepsy‐related search activity (difference, 8.98 units; 95% confidence interval [CI], 1.66–16.31; p = 0.016). No clear associations were observed at higher pressure levels or at low or high temperature. The association remained evident in several prespecified sensitivity analyses, including a log‐transformed outcome, but was attenuated in the positive‐only analysis and was not replicated using the simple search term epilessia . Secondary analyses showed no clear associations for relative humidity or precipitation, but an inverse association with high wind speed was found. Conclusions Lower mean sea‐level pressure was associated with increased population‐level epilepsy‐related Google search activity. The observed association corresponded to a 13.3‐hPa reduction in atmospheric pressure, a difference commonly encountered during the passage of low‐pressure weather systems. Although the direction of the association is broadly consistent with some studies reporting increased seizure occurrence during periods of lower atmospheric pressure, Google Trends reflects information‐seeking behavior rather than clinical outcomes. Therefore, these findings should be regarded as hypothesis‐generating and should not be interpreted as evidence that atmospheric pressure influences seizure occurrence.
Abstract Objective Lafora disease (LD) is a rare, fatal neurodegenerative epilepsy with no approved treatments. Empagliflozin, a sodium‐glucose cotransporter‐2 (SGLT2) inhibitor, has shown neuroprotective actions in preclinical models through modulation of glycogen metabolism, induction of a pseudo‐ketogenic state, improved mitochondrial efficiency, and reduction of excitatory neurotransmission. Based on this rationale, we conducted a first‐in‐human pilot study of empagliflozin in two genetically confirmed LD patients. Methods Two patients with genetically confirmed LD received empagliflozin 10 mg/day for 6 months. Serial assessments included safety and tolerability, seizure frequency, myoclonus severity, electroencephalographic findings, neuropsychological and motor evaluations, brain MRI, and quantitative FDG‐PET with regional Z ‐score analysis. Results Empagliflozin was safe and well tolerated, with no serious adverse events. Seizure frequency, myoclonus, and overall clinical status remained largely stable over 6 months, although some neuropsychological and motor measures showed variable changes between patients. EEG background activity and spike index were largely unchanged. Brain MRI showed stable mild cortical atrophy in both patients. In contrast, FDG‐PET revealed progressive and spatially expanding cerebral hypometabolism in both patients, with worsening regional Z ‐scores, particularly in the parietal and precuneus regions. Significance In this first‐in‐human, 6‐month pilot study, empagliflozin showed acceptable short‐term safety and feasibility in LD, but no definitive conclusions on efficacy can be drawn. The dissociation between relative electroclinical stability and progressive metabolic impairment suggests that quantitative FDG‐PET may represent a sensitive biomarker for monitoring disease trajectory in this ultra‐rare epilepsy.
