ArticleJournal of neuro-oncology2026
Feasibility of perampanel monotherapy for seizure management during awake craniotomy for glioma.
Article in Journal of neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study evaluated the feasibility of perampanel (PER) monotherapy for perioperative seizure management in patients undergoing awake craniotomy (AC) for glioma, with emphasis on preventing intraoperative intractable seizures.
methodsA retrospective analysis was conducted on patients who underwent AC at our institution between December 2024 and December 2025 and received PER monotherapy. PER was administered preoperatively at 2–4 mg. On the day of surgery, an additional 2 mg of PER was given intravenously at the start of the procedure and another 2 mg upon completion.
resultsOf 29 patients who underwent AC, five were excluded (four on multiple antiseizure medications and one who declined PER treatment), leaving 24 for analysis. Intraoperative seizures occurred in 3 patients (12.5%), all focal and controlled with cold saline irrigation. No intractable or generalized seizures occurred, and no awake procedures failed. Two patients had preoperative epilepsy, whereas one had no prior seizure history. Early postoperative seizures developed in 2 patients (8.3%), and complete seizure control was achieved in all patients by 3 months postoperatively. Treatment-related adverse effects occurred in one patient (4.2%) who developed a skin rash and discontinued PER. Among the 22 patients without early postoperative seizures, antiseizure medications were successfully discontinued within 6 months in 9 patients.
conclusionIn this cohort, PER provided perioperative seizure control with a very low incidence of adverse effects. These preliminary findings support the feasibility of PER monotherapy and provide a rationale for prospective evaluation. CLINICAL TRIAL NUMBER: Not applicable.
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