Self-reported quality of life outcomes after Cenobamate initiation

Cenobamate (CNB) has demonstrated to be highly effective for the treatment of focal epilepsy. However, further real-world data beyond seizure control are needed. We aimed to assess the self-reported quality of life (QoL) in patients who initiated CNB considering efficacy, safety, cognitive and psychiatric outcomes.

We prospectively recruited patients starting CNB in a tertiary center during 2 years. All patients had baseline and 6-month follow-up clinical visits, completing self-administered online questionnaires that included Hospital Anxiety and Depression Scale (HADS), Quality of life in Epilepsy Inventory-31 (QOLIE-31) and Short-Form-36 Health Survey (SF-36), as well as a Telephone-Montreal Cognitive Assessment (T-MoCA).

106 subjects (91.5% focal epilepsy) were included, with a mean age 43 years and 6-months retention rate of 84.1%. Median monthly seizure frequency decreased from 3 (IQR 1-11) to 0.66 (IQR 0-4) at 6 months (p<0.001). Seizure freedom was achieved in 26.5%. Adverse events occurred in 51.9%, mainly somnolence and dizziness. Baseline anxiety and depressive symptoms were present in 55.4% and 41.4% of patients respectively, remaining unchanged in the follow-up. Cognitive function slightly improved (median T-MoCA 16 to 17, p=0.009), particularly in responders and seizure-free patients. QoL scores were below normative values at baseline. After adjusted multiple regression analysis, seizure frequency reduction was significantly associated with the SF-36 Mental Component (β=4.030; 95%CI: 1.277-6.783; p=0.005), particularly in the emotional role domain (β=4.976; 95%CI: 1.442-8.509; p=0.007).

Greater seizure reduction in patients treated with CNB was associated with significant improvements in self-perceived QoL after 6 months.