Early Introduction of Cenobamate in Uncontrolled Focal Epilepsy: Insights from a Structured Controversy.

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Neurology and Therapy Pub Date : 2025-08-01 Epub Date: 2025-06-30 DOI:10.1007/s40120-025-00781-3

Angelo Labate, Claudio Liguori, Elena Tartara, Gemma Tumminelli, Annacarmen Nilo, Marta Piccioli, Filippo Dainese, Luigi Del Gaudio, Carlo Di Bonaventura

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引用次数: 0

Abstract

Introduction: Drug-resistant focal epilepsy, as defined by the International League Against Epilepsy (ILAE), is characterized by the failure to achieve seizure control despite the use of at least two appropriately chosen and adequately dosed antiseizure medications (ASMs). This condition affects approximately 30% of patients and represents a significant clinical challenge. Cenobamate, a novel ASM with a unique dual mechanism of action-enhancing inhibitory GABAergic currents and attenuating persistent sodium currents-has emerged as a promising therapeutic option for drug-resistant focal epilepsy.

Methods: This expert consensus document was developed using a structured controversy methodology, integrating real-world experience and a narrative review of the literature focusing on the role of cenobamate in the management of drug-resistant focal epilepsy. This manuscript synthesizes current evidence on cenobamate and provides clinical recommendations for its integration into epileptological practice.

Results: The expert panel findings support the early use of cenobamate following the failure of two ASMs, emphasizing its efficacy in achieving substantial seizure reduction and increasing the likelihood of seizure freedom. Early prescription of cenobamate may offer a valuable therapeutic opportunity for patients with refractory focal epilepsy, potentially reducing seizure-related complications and improving quality of life. Identified challenges include limited long-term safety data in specific populations and regional disparities in drug access.

Conclusion: Cenobamate represents a significant advancement in the treatment of drug-resistant focal epilepsy. Its early adoption in clinical practice has the potential to enhance patient outcomes. The expert panel provides recommendations that underscore individualized treatment planning, close monitoring during titration, and advocacy for improved accessibility. Continued research and policy initiatives are essential to fully realize the therapeutic potential of cenobamate.

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在未控制的局灶性癫痫中早期引入Cenobamate：来自结构性争议的见解。

根据国际抗癫痫联盟（ILAE）的定义，耐药局灶性癫痫的特点是，尽管使用了至少两种适当选择和适当剂量的抗癫痫药物（asm），但仍未能实现癫痫控制。这种情况影响了大约30%的患者，是一个重大的临床挑战。Cenobamate是一种新型ASM，具有独特的双重作用机制，增强抑制性gaba能电流和减弱持续性钠电流，已成为治疗耐药局灶性癫痫的一种有前景的选择。方法：本专家共识文件采用结构化争议方法，结合现实世界的经验和对文献的叙述性回顾，重点关注cenobamate在耐药局局性癫痫管理中的作用。这篇文章综合了目前关于cenobamate的证据，并为其纳入癫痫学实践提供了临床建议。结果：专家小组的研究结果支持在两次asm失败后早期使用cenobamate，强调其在实现大幅减少癫痫发作和增加癫痫发作自由可能性方面的功效。对于难治性局灶性癫痫患者，早期处方cenobamate可能提供宝贵的治疗机会，可能减少癫痫相关并发症并改善生活质量。确定的挑战包括特定人群的长期安全性数据有限以及药物获取方面的区域差异。结论：Cenobamate在治疗耐药局灶性癫痫方面取得了重大进展。它在临床实践中的早期采用有可能提高患者的治疗效果。专家小组提出的建议强调个体化治疗计划、滴定期间密切监测以及倡导改善可及性。持续的研究和政策举措对于充分发挥cenobamate的治疗潜力至关重要。

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. 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