Abstracts

Rationale: Cenobamate is approved in the U.S. and EU for treatment of focal seizures in adults. A previous analysis of adjunctive cenobamate in 28 patients with uncontrolled focal seizures who were living in a group home or living with a developmental disability found substantial reduction in seizure frequency, including seizure freedom in some patients, during 6 months of routine clinical practice. Here we report results for these patients following 12 months of cenobamate treatment.

Methods: Adults 18 years or older with uncontrolled focal seizures receiving treatment in routine clinical practice and on stable doses of 2 or more antiseizure medications (ASMs) were included. Data (e.g., seizure frequency, dosing) were collected retrospectively from medical records and patient seizure diaries.

Results: The 28 patients (16 male/12 female) had a mean age of 38.4 years (range, 19-64 years) and mean epilepsy duration of 34.9 years (range, 15-62 years) at the start of cenobamate treatment; 53.6% of patients (15/28) were receiving ≥ 4 ASMs. Mean seizure frequency in the 2-3 months before starting cenobamate was 20.2 seizures per month (median = 3.0). Reported seizures included focal aware motor (n=2), focal impaired awareness (n=11), and focal to bilateral tonic-clonic (FBTC n=16; 1 patient had both focal impaired awareness and FBTC seizures). Twenty-five of 28 patients (89.3%) were taking cenobamate at 12 months. Mean seizure frequency over Months 11 and 12 was 6.4 seizures. Two patients discontinued cenobamate before Month 5 and one patient died from COVID-19 at Month 7. Among the patients who were taking cenobamate at 12 months, 92.3% had a ≥ 50% reduction in seizure frequency over Months 11 and 12 (82.8% of overall patients) and 61.5% were seizure-free (55.2% of overall patients) during this time (Figure). The mean cenobamate dose at 12 months was 193 mg/day (range 50-300 mg/day). Dose reductions, including discontinuation, of 46 concomitant ASMs were reported at Month 12. Discontinued ASMs included lacosamide (n=5), perampanel (n=3), clobazam (n=3), cannabidiol (n=1), lamotrigine (n=1), topiramate (n=1), and zonisamide (n=1). Dose reductions were most common with lacosamide (12 patients; median reduction = -50%), brivaracetam (4 patients, -50%), clobazam (4 patients; -80%), lamotrigine (3 patients; -50%), and perampanel (3 patients; all -100%).

Conclusions: During routine clinical practice for the treatment of uncontrolled focal seizures in patients living in a group home or living with developmental disability, substantial reduction in seizure frequency occurred at 12 months with adjunctive cenobamate.

Funding: Medical writing support funded by SK Life Science, Inc.