We report a 23-year-old man with intractable startleinduced epilepsy. The most annoying symptom was a partial startle-induced seizure resulting in falling. Multiple antiepileptic drugs showed no efficacy to startle-induced seizures. However, only 1 mg of perampanel (PER) at bedtime decreased his startle-induced seizures dramatically without any adverse events. PER, even though a low dosage could be effective for intractable startle-induced epilepsy.