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

被引：0

作者：

Labate, Angelo ^{[1
]}

Liguori, Claudio ^{[2
,3
]}

Tartara, Elena ^{[4
,5
]}

Tumminelli, Gemma ^{[6
]}

Nilo, Annacarmen ^{[7
]}

Piccioli, Marta ^{[8
]}

Dainese, Filippo ^{[9
]}

Del Gaudio, Luigi ^{[10
]}

Di Bonaventura, Carlo ^{[11
]}

机构：

[1] Univ Messina, Neurophysiopathol & Movement Disorders Clin, Messina, Italy

[2] Univ Hosp Tor Vergata, Epilepsy Ctr, Neurol Unit, Rome, Italy

[3] Univ Roma Tor Vergata, Dept Syst Med, Rome, Italy

[4] IRCCS Mondino Fdn, Epilepsy Ctr, Pavia, Italy

[5] European Reference Network EpiCARE, Bologna, Italy

[6] ASST Santi Paolo & Carlo, Epilepsy Ctr, Child Neurol Unit, Milan, Italy

[7] Univ Udine, Dept Med, Clin Neurol, Udine, Italy

[8] ASL Roma 1, UOC Neurol, San Filippo Neri, Rome, Italy

[9] Univ Hosp Padova, Dept Neurosci, Unit Neurol & Neurophysiol, Padua, Italy

[10] ASL Napoli 3 Sud, Neurol, PO San Leonardo, Naples, Italy

[11] Sapienza Univ Rome, Dept Human Neurosci, Rome, Italy

来源：

NEUROLOGY AND THERAPY | 2025年 / 14卷 / 04期

关键词：

Cenobamate; Drug-resistant focal epilepsy; Antiseizure medications (ASMs); Early add-on; Seizure control; MULTICENTER; SEIZURES; EFFICACY; RISK;

D O I：

10.1007/s40120-025-00781-3

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

IntroductionDrug-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.MethodsThis 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.ResultsThe 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.ConclusionCenobamate 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.

引用

页码：1671 / 1684

页数：14

共 54 条

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