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Ketamine + perampanel is a dual anti-glutamatergic combination therapy being investigated for the treatment of super-refractory status epilepticus (SRSE), particularly in patients following cardiac arrest (post-anoxic SRSE). This combination targets excitotoxicity by simultaneously inhibiting two key glutamate receptors: ketamine acts as an NMDA receptor antagonist, while perampanel is a selective, non-competitive AMPA receptor antagonist. The therapy, evaluated in the SUPER-CAT study led by the University of Milano Bicocca, involves continuous intravenous infusion of ketamine alongside enteral administration of perampanel. This synergistic approach aims to halt seizure activity that has failed to respond to standard anesthetic and anti-seizure medications.
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