Positioning Cenobamate in the Treatment Algorithm of Focal Epilepsy: Seizure Control and Benefits Beyond Seizures.

IF 4.7 3区医学 Q1 CLINICAL NEUROLOGY

Neurology and Therapy Pub Date : 2026-10-16 DOI:10.1007/s40120-026-01067-y

Manuel Toledo, Vicente Villanueva, Irene García-Morales, Juan Jesús Rodríguez-Uranga, Mar Carreño, José María Serratosa

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Abstract

This work integrates the opinion on the current use of cenobamate (CNB) of an expert panel structured across seven thematic domains: efficacy, patient profiles, titration and dosing, pharmacokinetic interactions, safety, parallel effects, and therapeutic positioning. According to personal experience and scientific evidence, experts unanimously regarded CNB as likely more efficacious than other newer-generation antiseizure medications (ASMs), particularly based on the long-term sustained seizure-freedom rates, despite the absence of comparative head-to-head studies. Priority candidates are patients with focal epilepsy failing two or more ASMs, including older patients, with a clear inclination toward earlier introduction. Initial response is expected at 100-200 mg/day, although maintenance is typically 200 mg/day or higher, alongside reduction of concomitant ASMs particularly sodium channel blockers and benzodiazepines. The most relevant drug-drug interaction is with clobazam, which may have a synergistic efficacy effect and in parallel increases plasma concentrations of clobazam, thereby inducing adverse events. The most frequent adverse events (somnolence, dizziness, fatigue) are dose-dependent and are reduced by anticipatory reduction of concomitant medication. Beyond seizure reduction, an early intervention with CNB may modify the prognosis of epilepsy, reducing the long-term mortality risk, cognitive impairment, or psychiatric disorders. The panel converged on a priority to position CNB as a third-line treatment in the focal epilepsy treatment algorithm owing to its high efficacy, which will probably lead to modification of the long-term global outcomes of people with epilepsy.

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在局灶性癫痫的治疗算法中定位Cenobamate：癫痫发作控制和癫痫发作以外的益处。

这项工作整合了一个专家小组对目前使用cenobamate （CNB）的意见，该专家小组横跨七个主题领域：疗效、患者概况、滴定和剂量、药代动力学相互作用、安全性、平行效应和治疗定位。根据个人经验和科学证据，专家们一致认为CNB可能比其他新一代抗癫痫药物（asm）更有效，特别是基于长期持续的癫痫自由率，尽管缺乏比较的头对头研究。优先考虑局灶性癫痫两次或两次以上asm失败的患者，包括明显倾向于早期引入的老年患者。最初的反应预期为100- 200mg /天，尽管维持通常为200mg /天或更高，同时减少伴随的asm，特别是钠通道阻滞剂和苯二氮卓类药物。最相关的药物-药物相互作用是与氯巴唑，它可能具有协同效应，同时增加氯巴唑的血浆浓度，从而诱发不良事件。最常见的不良事件（嗜睡、头晕、疲劳）是剂量依赖性的，可通过预期减少伴随用药而减少。除了减少癫痫发作，CNB的早期干预可能会改变癫痫的预后，降低长期死亡风险、认知障碍或精神障碍。由于CNB疗效高，专家组一致将其列为局局癫痫治疗算法中的三线治疗，这可能会改变癫痫患者的长期全球结局。

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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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