Cenobamate efficacy in specific populations

Most people with epilepsy are able to achieve good seizure control with currently available medications. However, despite the development of more than 20 new antiseizure medications (ASMs) over the past 30 years, approximately one third of patients (both pediatric and adult) are treatment-resistant and at risk of increased morbidity and mortality, including sudden unexpected death in epilepsy. The management of epilepsy in these populations can be complex. Metabolic differences in older people and pediatric patients can alter drug metabolism, increasing the risk of adverse drug effects. Comorbid conditions, potential or existing polypharmacy, and age-related physiological changes need to be considered when treating these patients. Rare developmental epileptic encephalopathies such as Lennox–Gastaut syndrome and Dravet syndrome are typically diagnosed in childhood and have proven to be refractory to treatment and to have high mortality rates. Here, we provide an overview of ASM use in patients with refractory epilepsy, in older patients, and in pediatric patients, with a focus on the efficacy outcomes, safety, and tolerability observed with a newer ASM, cenobamate.