Initial Experience with Cenobamate for Drug Refractory Epilepsy at a Canadian Pediatric Tertiary Care Center

Cenobamate is a novel anti-seizure medication (ASM) in the alkyl carbamate family with a dual mechanism of action: targeting persistent sodium currents and positively modulating γ-aminobutyric acid type A receptors independent of benzodiazepines. Approved by Health Canada in June 2023, it offers an additional treatment option for seizures. This study's objective was to review the real-world experience with cenobamate in a Provincial Comprehensive Epilepsy Program, soon after its availability in Canada.

A retrospective study of all patients prescribed cenobamate from June 2023 to May 2025.

The study population comprised 36 patients with a median age of 18 years (range: 8-23 years). Seizure etiology was structural (n = 18) and genetic (n = 13). Prior to starting cenobamate, patients had tried a mean of 10 ASMs. Additionally, 19 (53%) had undergone epilepsy surgery, 3 (8%) had failed the ketogenic diet and 11 (31%) were treated with neuromodulation. Following a mean duration of 10.5 months of treatment with cenobamate, 50% (18/36) had a > 50% seizure reduction, and 20% (7/36) had a 25%-50% reduction of seizures. Fourteen percent (5/38) of patients were seizure-free at the most recent follow-up. The median dose was 200 mg (range: 62.5-400 mg). Eighteen patients (50%) experienced adverse effects (AEs), including dizziness, drowsiness, nausea and vomiting. However, only two patients discontinued cenobamate due to AEs. No patients discontinued cenobamate due to a lack of efficacy.

This real-world study demonstrates the efficacy and tolerability of cenobamate in patients with highly drug-resistant epilepsy.