Steps towards seizure freedom with the use of Cenobamate

Cenobamate (CNB) is an antiseizure medication (ASM) that may change the prescription across the time. Our study sought to compare the rate of seizure-freedom patients after one year of CNB use experience in a single tertiary centre.

All patients with a minimum follow-up of one year who used CNB between 2021 and 2022 (n = 66) were compared to those who treated during 2023 (n = 126).

In 2023, patients were older, used fewer concomitant ASMs (IQR 2-3 in 2023 vs 3-4 in 2022), and had a lower seizure frequency. Seizure-freedom rates at 12 months in 2021-2022 cohort were 16.7 %, and 23 % in 2023. The responder rate was greater than 60 % in both cohorts. The CNB titration was slower in the 2023 cohort, the median dose achieved was 225 mg in 2021-2022 and 200 mg in 2023. Concomitant ASMs were reduced in 70 % for both groups. The adverse event rate was nearly 60 %, most of them central nervous system-related. The CNB retention rate at 12 months was over 80 % in both groups. In 2023, up to 12 % of patients remained in monotherapy after 12 months.

This is the first real-world data series that compares the use of CNB in two cohorts of a single centre. One year follow-up seizure freedom rates above 20% can be achieved by a proper patient selection, CNB dose increase and ASM dose reduction, which eventually lead to CNB monotherapy in some cases.