Rationale:
Most patients in adjunctive treatment trials for treatment-resistant focal onset epilepsy do not benefit with improved Quality of Life in Epilepsy Inventory-31 (QOLIE-31) scores despite significant reductions in seizures. Previous studies, however, suggest this often may be due to limited numbers of patients with drug resistant epilepsy who benefit from marked seizure reduction with new treatments. We determined whether patients at JHU who had strong responses to three to eight years of cenobamate treatment had high QOLIE-31 scores compared to low treatment-responders.
Method:
In a single-center analysis, 49 adults were enrolled in long-term cenobamate safety treatment studies and were evaluated after two to seven years of treatment. Patients’ baseline seizure frequencies were compared to their last three months of treatment; adverse events were tabulated. At the close of the study, patients continuing treatment were administered the QOLIE-31 survey and a separate survey to evaluate changes in independence and epilepsy-linked disability; caregiver’s independence was screened. Results49 adults with focal-onset resistant epilepsy were treated with cenobamate—37 (76%) continued treatment for three to eight years (median exposure 5.6 years). The mean number of previously failed antiepileptic drugs across all patients was 8.7 (s=2.6). During their last three months of treatment, 45% of patients had responder rates of >75%; 29% had responder rates >90% and 16% were seizure free. Higher responder rates were associated with increasing cenobamate doses across the 100 to 400 mg/day dose range (p< 0.001).
The mean for overall QOLIE-31 scores was 68 (s=18), with individual scores ranging from 32 to 96. The average QOLIE-31 increased only slightly from 60 for < 50% responders to 71 for >50% responders and 73 for >75% responders (see Figure 1). Those with >90% responses and 100% responses, however, had significantly higher QOLIE-31 scores than those with < 50% responses (p< 0.01). High treatment responders with intellectual disability also had high QOLIE-31 scores. The QOLIE-31 domain increasing the most for high responders compared to low responders was energy-fatigue.
Conclusion:
Similar to previous surgery series and studies of non-refractory patients with epilepsy, many patients with treatment resistant epilepsy had strong treatment responses to cenobamate and high QOLIE-31 scores when compared to non-treatment responders.
Funding:
:The author(s) received no financial support for the research, authorship, and/or publication of this article.
FIGURES
Figure 1