Objective:

Background:

Cenobamate is approved in the US and EU for treatment of focal seizures in adults.

Design/Methods:

This retrospective medical record review included 28 adults (16 male/12 female; mean [range] age, 38.4 [19-64] years) with uncontrolled focal seizures receiving treatment in routine clinical practice and on stable doses of 2 or more antiseizure medications (ASMs). 

Results:

Mean seizure frequency in the 2-3 months before starting cenobamate was 20.2 seizures per month (median, 3.0); 53.6% of patients (15/28) were receiving ≥4 ASMs at cenobamate initiation. Reported seizures included focal aware motor (n=2), focal impaired awareness (n=11), and focal to bilateral tonic-clonic (FBTC; n=16; 1 patient had both focal impaired awareness and FBTC seizures). At 12 months, 25 of 28 patients (89.3%) were taking cenobamate. Mean seizure frequency over Months 11 and 12 was 6.4 seizures. Two patients discontinued cenobamate before Month 5, and 1 patient died from COVID-19 at Month 7. Among those taking cenobamate at 12 months, 92.3% had a ≥50% reduction in seizure frequency over Months 11 and 12 (82.8% of overall patients), and 61.5% were seizure-free (55.2% of overall patients). The mean (range) cenobamate dose at 12 months was 193 (50-300) mg/day. Dose reductions, including discontinuation, of 46 concomitant ASMs were reported at Month 12. Discontinued ASMs included lacosamide (n=5), perampanel (n=3), clobazam (n=3), cannabidiol (n=1), lamotrigine (n=1), topiramate (n=1), and zonisamide (n=1). Dose reductions were most common with lacosamide (n=12; median reduction, 50%), brivaracetam (n=4, 50%), clobazam (n=4; 80%), lamotrigine (n=3; 50%), and perampanel (n=3; all 100%). 

Conclusions:

Patients living in a group home or with developmental disability achieved substantial reduction in seizure frequency at 12 months with adjunctive cenobamate.