Delayed and Deferred Surgery Associated with Cenobamate Use in People with Drug Resistant Focal Epilepsy
Jacob Pellinen1, Stefan Sillau1, Aimee Bui2, Alexandra Danciutiu1, Lesley Kaye1, Ashvin Sood3, Louis Ferrari4, William Rosenfeld5, Christopher Elder6
1University of Colorado, 2Rocky Vista University College of Osteopathic Medicine, 3SSM Health, 4SK Life Science, 5Comprehensive Epilepsy Care Center for Children and Adults, 6New York University Comprehensive Epilepsy Center
Objective:
To evaluate whether surgery was obtained within 12 months for patients who received cenobamate as a treatment during the presurgical evaluation and those who did not, comparing across years before and after cenobamate approval at a single center.
Background:
Cenobamate is a highly effective antiseizure medication for patients with focal epilepsy, including those being considered for epilepsy surgery. Prior recommendations have suggested some of this population may be able to avoid surgery.
Design/Methods:
Patients undergoing surgical evaluation for drug resistant focal epilepsy at the University of Colorado during 2018 and 2023 who had at least 12 months of follow up data were analyzed. Comparison years allowed analysis of 12 months follow up and avoiding the confounding effect of COVID-19 pandemic on surgical volume, while comparing times before and after cenobamate’s FDA approval. The primary outcome (surgery within 12 months) was modeled with potential explanatory variables using multiple logistic regression. A p-value of <.05 was considered significant.
Results:
After controlling for potentially confounding variables, cenobamate use during the pre-surgical evaluation period was associated with an estimated 87% decrease in the odds of surgery within 12 months compared to not being prescribed this medication (odds ratio = 0.13, 95% CI 0.04 to 0.42, p < 0.001) (Figure 1). Being Hispanic or Latino was associated with an estimated 77% decrease in the odds of surgery within 12 months (odds ratio = 0.23, 95% CI 0.09 to 0.61, p < 0.01). Year of evaluation (2023 vs 2018), education level, age, and sex, did not have significant independent associations with undergoing surgery within 12 months.
Conclusions:
Patients with drug resistant focal epilepsy undergoing evaluation for epilepsy surgery may benefit from cenobamate. The delay-to-surgery identified among Hispanic and Latino patients suggests potential barriers to care warranting further investigation.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.