Authors :
Presenting Author: Ushtar Amin, MD – University of South Florida
Marina Azevedo, BS – University of South Florida
Karla Mora Rodríguez, MD – TGH and USF
Zuha Mheir-Al-Saadi, DO – University of South Florida
Briana Merkher, MD – University of South Florida
Dominique Cook, BS – University of South Florida
Kristen Zemina, MD – University of South Florida
Angélica Rivera-Cruz, MD – University of South Florida
Selim Benbadis, MD – University of South Florida
Rationale:
Cenobamate (CNB) is a recent and effective antiseizure medication (ASM) approved for focal epilepsy. Responsive Neurostimulation (RNS) provides long-term electrocorticography (ECoG). Our goal is to evaluate the response to CNB in patients with drug resistant epilepsy (DRE) implanted with RNS, providing objective seizure quantification.
Methods:
We retrospectively reviewed the ECoGs of patients with DRE who were treated with RNS 6 months pre and post reaching a therapeutic CNB dose (200 mg daily). We excluded patients who were lost to follow-up; patients who were explanted; patients who could not tolerate CNB at the 200 mg daily dose; patients whose ECoGs were not a reliable measure of their seizures; patients who were on CNB prior to RNS implantation; patients who were non-compliant with RNS uploads; patients who were recently implanted without enough post implant data; patients with a second neuromodulation device; patients who had resective surgery during the 1-year period ECoGs were reviewed; patients who had additional anti-seizure medications added after 200 mg CNB was reached.
Results:
Of the 52 patients with RNS, 16 (30%) were treated with CNB. Seven of these 16 patients met criteria for inclusion in the final analysis. Patient distribution is summarized in Figure 1. At six months of adjunctive CNB, 6 of 7 patients (85%) experienced a reduction in seizure frequency. The median seizure reduction was 42%. Following initiation of CNB 200 mg, RNS settings remained stable for an average of 4.7 months (Min: 3 months; Max: 6 months). Results are summarized in Table 1.