Authors :
Presenting Author: Alperan Yavuz, MD – University of Utah
Mert Karatas, MD – Neurology – University of Utah; Brian Johnson, MD – Assistant Professor, Neurology, University of Utah; Blake Newman, MD – Assistant Professor, Neurology, University of Utah; Angela Peters, MD – Assistant Professor, Neurology, University of Utah; Sindhu Richards, MD – Assistant Professor, Neurology, University of Utah; Amir Arain, MD – Assistant Professor, Neurology, University of Utah
Rationale:
The real-world experience with the efficacy and tolerability of newly approved antiseizure medications (ASMs) often diverges from findings in controlled clinical trials. Cenobamate (CBM) is one of the latest ASMs to hit the market, demonstrating a 64% responder rate and 20% seizure freedom during placebo-controlled trials. Given the high prevalence of comorbid depression in epilepsy (approximately 40%), we conducted an analysis to investigate the impact of CBM on mood and tolerability when administered as an add-on therapy in patients initiating CBM treatment at our institution between May 2020 and July 2023.
Methods:
In this study, we conducted a comprehensive review of adult patients seen by every epileptologist at our hospital between May 2020 and July 2023. We included patients who had both pre and post-assessments using the "Patient Health Questionnaire-9" survey. Data collection encompassed parameters such as age, age of seizure onset, gender, reasons for medication change, baseline seizure frequency, seizure frequency at the last follow-up, seizure improvement, and baseline antidepressant medication use (if applicable). Seizure classification included Focal Impaired Awareness Seizures (FIAS), Secondarily Generalized Tonic-Clonic Seizures (SGTC). Focal Aware Seizures (FAS) were considered only when motor involvement was present. This comprehensive approach allowed for a thorough evaluation of treatment outcomes and related factors in the adult epilepsy population treated by our hospital's epileptologists during the specified timeframe.
Results:
Among the 71 patients (39 women) meeting inclusion criteria, the mean age was 40.2 years, median age 38 (21 to 68). The mean age at seizure onset was 15.7 years, and the mean duration of CBM use was 17 months (median: 15.3 months). At the last follow-up, 89% of patients remained on CBM.
Mean baseline seizure frequency was 20.1 per month (median: 6), decreasing to 15.2 seizures per month at the last follow-up (median: 2). A total of 62% of patients experienced an improvement in seizure frequency, with 26.7% achieving seizure freedom, resulting in an overall seizure frequency reduction of 24%.
In assessing mood, 16.2% of patients exhibited no change in their PHQ-9 scores from baseline after CBM use, while 51.3% experienced a decrease in PHQ-9 score, and 32.4% demonstrated an increase in their PHQ-9 scores. Importantly, 31% of these patients were concurrently on baseline antidepressant medication.
Conclusions:
Cenobamate has a significant impact on seizure frequency while no significant worsening of mood as evidenced by decreased PHQ-9 scores. The improvement in seizure frequency may have a positive effect on mood, enhancing patients' overall quality of life. Further research is needed to explore these mechanisms and optimize patient selection for CBM therapy.
Funding: No funding