Batool Hussain1, Kiran Kanth2, Jeffrey Kennedy3, Shubhi Agrawal4
1UC Davis Neurology, 2UC Davis Medical Center Department of Neurology, 3University of California, Davis, 4University of California Davis
Objective:
Evaluating the real-world outcomes of adjunctive Cenobamate (CNB) therapy in patients with drug-resistant epilepsy over an extended follow-up.
Background:
Phase 3 cenobamate trials showed high seizure freedom rates in refractory focal epilepsy patients. This study evaluates effectiveness of CNB over an extended period, outside of rigorously controlled trials.
Design/Methods:
This retrospective study was conducted at The University of California, Davis Epilepsy Clinic. Patients older than 18 years who started CNB were included. Data were collected on epilepsy history, treatment history, seizure frequency prior to initiation, seizure frequency at last follow up or at failure of therapy, adverse events, and dose at last follow-up. Failure of therapy was defined as discontinuation of drug for any reason or initiation of other epilepsy treatments.
Results:
59 patients were included in this study, of which 75.9% had focal epilepsy, 13% had generalized epilepsy, and 11 % had an unknown type or an epilepsy syndrome. Follow-up duration ranged from 0.2 to 3.5 years, with a median of 1.6 years. Median number of failed antiseizure medications (ASM) was four. 51% patients had failed epilepsy surgery or neuromodulation prior to initiation. 45.6% of patients eventually failed on CNB. The median time to failure was 248 days with a range of 7 to 841 days. 15% failed due to incomplete efficacy, 20% due to side effects and the rest due to both. 27% patients discontinued the treatment. 12% patients were seizure free. Common adverse effects included fatigue (17%), somnolence (12%), dizziness (12%), imbalance (12%).
Conclusions:
Cenobamate shows good efficacy and retention over extended follow-up in patients with refractory epilepsy. Seizure freedom rates are much higher than historically expected with medical management in this population. Many patients discontinued due to fatigue, sleepiness, and dizziness. Some of these may be due to its many interactions with other ASM.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.