Cenobamate: New Antiseizure Medication with High Seizure Freedom and Dual Mechanisms of Action

BCenobamate is a newly approved antiseizure medication for patients with focal epilepsy. Even though preclinical study revealed potential for both generalized and focal epilepsy, clinical study has been completed in refractory focal epilepsy patients to date. The efficacy of cenobamate at 100 to 400 mg per day has been strongly supported by two pivotal studies with significant seizure reduction and approximately 20% of seizure freedom rate among the refractory epilepsy patients. Cenobamate was well tolerated and the most frequently reported adverse effects during studies were somnolence and dizziness. In order to mitigate the potential hypersensitivity drug rash with eosinophilia and systemic symptoms (DRESS), cenobamate should be started at a low dosage of 12.5 mg per day and titrated at 2-week intervals. Cenobamate has dual mechanisms of action of inhibiting excitatory sodium channels and enhancing inhibitory GABAA currents as an allostatic modulator.