Presurgical Use of Cenobamate for Adult and Pediatric Patients Referred for Epilepsy Surgery: Expert Panel Recommendations.

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Neurology and Therapy Pub Date : 2024-10-01 Epub Date: 2024-08-18 DOI:10.1007/s40120-024-00651-4

Kenneth D Laxer, Christopher J Elder, Giancarlo Di Gennaro, Louis Ferrari, Gregory L Krauss, Jacob Pellinen, William E Rosenfeld, Vicente Villanueva

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Abstract

Cenobamate has demonstrated efficacy in patients with treatment-resistant epilepsy, including patients who continued to have seizures after epilepsy surgery. This article provides recommendations for cenobamate use in patients referred for epilepsy surgery evaluation. A panel of six senior epileptologists from the United States and Europe with experience in presurgical evaluation of patients with epilepsy and in the use of antiseizure medications (ASMs) was convened to provide consensus recommendations for the use of cenobamate in patients referred for epilepsy surgery evaluation. Many patients referred for surgical evaluation may benefit from ASM optimization; both ASM and surgical treatment should be individualized. Based on previous clinical studies and the authors' clinical experience with cenobamate, a substantial proportion of patients with treatment-resistant epilepsy can become seizure-free with cenobamate. We recommend a cenobamate trial and ASM optimization in parallel with presurgical evaluations. Cenobamate can be started before phase two monitoring, especially in patients who are found to be suboptimal surgery candidates. As neurostimulation therapies are generally palliative, we recommend trying cenobamate before vagus nerve stimulation (VNS), deep brain stimulation, or responsive neurostimulation (RNS). In surgically remediable cases (mesial temporal sclerosis, benign discrete lesion in non-eloquent cortex, cavernous angioma, etc.), cenobamate use should not delay imminent surgery; however, a patient may decide to defer or even cancel surgery should they achieve sustained seizure freedom with cenobamate. This decision should be made on an individual, case-by-case basis based on seizure etiology, patient preferences, potential surgical risks (mortality and morbidity), and likely surgical outcome. The addition of cenobamate after unsuccessful surgery or palliative neuromodulation may also be associated with better outcomes.

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对转诊接受癫痫手术的成人和儿童患者在术前使用塞诺巴马酯：专家组建议。

塞诺巴马特对耐药性癫痫患者（包括癫痫手术后仍有癫痫发作的患者）具有疗效。本文对转诊接受癫痫手术评估的患者使用塞诺巴马特提出了建议。一个由来自美国和欧洲的六位资深癫痫专家组成的小组在癫痫患者的手术前评估和抗癫痫药物（ASMs）的使用方面拥有丰富的经验，该小组旨在为转诊接受癫痫手术评估的患者使用仙诺巴马酯提供共识建议。许多转诊接受手术评估的患者可能会受益于 ASM 的优化；ASM 和手术治疗均应个体化。根据以往的临床研究和作者使用西诺巴马特的临床经验，相当一部分耐药癫痫患者可以通过使用西诺巴马特实现无发作。我们建议在进行手术前评估的同时，进行塞诺巴马特试验和 ASM 优化。塞诺巴马特可以在第二阶段监测之前开始使用，尤其是对于那些被认为不适合手术的患者。由于神经刺激疗法通常是缓解性的，我们建议在迷走神经刺激（VNS）、脑深部刺激或反应性神经刺激（RNS）之前试用塞诺巴马特。对于可通过手术治愈的病例（颞中叶硬化症、非麋鹿皮质良性离散性病变、海绵状血管瘤等），使用西诺巴马特不应延迟即将进行的手术；但是，如果患者通过使用西诺巴马特获得持续的癫痫发作自由，他们可以决定推迟甚至取消手术。应根据癫痫发作的病因、患者的偏好、潜在的手术风险（死亡率和发病率）以及可能的手术结果，因人而异地做出这一决定。在不成功的手术或姑息性神经调控后加用塞诺巴马特也可能会带来更好的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology and Therapy CLINICAL NEUROLOGY-

CiteScore

5.40

自引率

8.10%

发文量

103

审稿时长

6 weeks

期刊介绍： Aims and Scope Neurology and Therapy aims to provide reliable and inclusive, rapid publication for all therapy related research for neurological indications, supporting the timely dissemination of research with a global reach, to help advance scientific discovery and support clinical practice. Neurology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of neurological and psychiatric therapies, (also covering surgery and devices). Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial designs, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Neurology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research. Rapid Publication The journal’s rapid publication timelines aim for a peer review decision within 2 weeks of submission. If an article is accepted, it will be published online 3-4 weeks from acceptance. These rapid timelines are achieved through the combination of a dedicated in-house editorial team, who closely manage article workflow, and an extensive Editorial and Advisory Board who assist with rapid peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model, this allows for the rapid and efficient communication of the latest research and reviews to support scientific discovery and clinical practice. Open Access All articles published by Neurology and Therapy are open access. Personal Service The journal’s dedicated in-house editorial team offer a personal “concierge service” meaning that authors will always have a personal point of contact able to update them on the status of their manuscript. The editorial team check all manuscripts to ensure that articles conform to the most recent COPE and ICMJE publishing guidelines. This supports the publication of ethically sound and transparent research. We also encourage pre-submission enquiries and are always happy to provide a confidential assessment of manuscripts. 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