Epilepsy is known to comorbid with Alzheimer’s disease. It can promote cognitive decline, and eventually worsen their prognosis and mortality. It is sometimes difficult to find a suitable drug because of the adverse effects. Perampanel has a unique mechanism of action that antagonizes α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid type glutamate receptor. Here, we report a case of severe dementia due to Alzheimer’s disease with intractable epilepsy, which perampanel effected for controlling seizures with less adverse effects. The subject is an 89-year-old Japanese woman with severe dementia due to Alzheimer’s disease and intractable myoclonic epilepsy. She also had psychiatric symptoms, such as circadian rhythm disorder and irritability. Valproic acid, lacosamide, or carbamazepine were prescribed, but none of them was effective. Shortly after perampanel started, however, myoclonus and these psychiatric symptoms improved. Moreover, it did not cause any obvious adverse effects, which made it possible to continue perampanel until the end of her life. Perampanel may be useful for controlling intractable epilepsy accompanied by Alzheimer’s disease. It may also improve psychiatric symptoms with less adverse effect. Accumulation of studies is necessary to evaluate the effectiveness of perampanel on the epilepsy of Alzheimer’s disease patients and further understand that mechanism.
Valproic acid, lacosamide, or carbamazepine were prescribed to control seizures and improve psychiatric symptoms. They were used in a sufficient dose and for enough time to determine the effect, but in the result, none of them none was effective. Perampanel 4 mg started as expected in its unique action. Shortly after that, myoclonus and psychiatric symptoms such as shouting and circadian rhythm sleep disorder improved. Moreover, her appetite improved and she began to eat well. There were no abnormal bursts in the electro-encephalography performed after perampanel started, which confirmed its effectiveness on epilepsy. Perampanel was reduced to 2 mg, as she got gradually weakened by aging. She could eat without severe swallowing dysfunction until she died of old age about one year after hospitalization.
Conflicts of Interest
Conflict of Interest
The authors declare that they have no conflicts of interest.