RT Journal Article
SR Electronic
T1 Cenobamate in Generalized Epilepsy and Combined Generalized and Focal Epilepsy
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP e200133
DO 10.1212/CPJ.0000000000200133
VO 13
IS 2
A1 Shruti Agashe
A1 Gregory Worrell
A1 Jeffrey Britton
A1 Katherine Noe
A1 Anthony Ritaccio
A1 Elaine C. Wirrell
A1 Katherine C. Nickels
A1 Gregory D. Cascino
A1 David Burkholder
YR 2023
UL http://cp.neurology.org/content/13/2/e200133.abstract
AB Background and Objectives Cenobamate (CNB) is a United States Food and Drug Administration–approved antiseizure medication (ASM) for focal-onset seizures; however, its potential clinical effectiveness as a broad-spectrum ASM is not established. CNB has a proposed dual mechanism of action with preferential blockade of persistent sodium currents and positive allosteric modulation of the γ-aminobutyric acid-A (GABA-A) receptor. We evaluated the efficacy of CNB in drug refractory patients with genetic generalized epilepsies (GGE) or combined generalized and focal epilepsies (CGFE), including developmental and epileptic encephalopathies.Methods We performed a retrospective review and identified the following: cohort 1 (n = 4) with GGE, of which 2 patients had idiopathic generalized epilepsy, and cohort 2 with CGFE (n = 9), of which 4 patients had Lennox-Gastaut syndrome and 1 had Dravet syndrome.Results In cohort 1, all 3 patients with frequent generalized tonic-clonic seizures (GTCs) had a greater than 50% reduction in GTCs. In cohort 2, reduction in both generalized and focal-onset seizures was noted. In these groups together, the mean reduction of all seizure types was 58%, and ≥50% responder rate was 70% (SD = ±34.16, median = 50%). No worsening of generalized-onset seizures occurred in either cohort. Seventy-seven percent of patients experienced side effects, warranting a modification of treatment managed by slower titration, dose reduction of CNB, or discontinuing other ASMs.Discussion In our retrospective case series, CNB seems to be an effective ASM for patients with drug-resistant GGE and CGFE. The ongoing CNB trial assessing effectiveness for primary GTCs will provide more data on generalized-onset seizures.Classification of Evidence This study provides Class IV evidence that CNB in generalized epilepsy and combined generalized and focal epilepsy reduces seizure frequency.