This is a pilot trial to test perampanel (Fycompa; Eisai, Inc.) in ALS patients. The
investigators will focus on safety and preliminary signs of efficacy. Perampanel is approved
by the FDA for treatment of seizures in patients with epilepsy. In this study, perampanel
will be used off-label for adults with ALS at an oral medication dose on the low end of the
recommended dose range for epilepsy. This study will consist of two treatments arms:
perampanel and matching placebo randomized at a 1:1 ratio. Subjects will receive medication
for 9 months.