Fig. 1

Clinical course of the patient. The patient, aged 24 years, was taking valproate, sodium bromide, and zonisamide as antiseizure medications. Seizures were triggered by aspiration pneumonia and fever. Despite treatment, dysphagia and recurrent pneumonia led to respiratory failure, necessitating intubation, tracheostomy, and gastrostomy for nutrition and medication administration. Seizures persisted, triggered by infections and elevated body temperature, resulting in status epilepticus (SE) treated with high doses of phenobarbital, midazolam, or thiopental. We suspected that the seizures and SEs may have been caused by fever due to infection and hyperthermia due to zonisamide, so we treated the infection early and discontinued zonisamide. After switching from zonisamide to perampanel, SE and seizure frequency improved