Melnick Susan M, Misra Sunita N, Kamin Marc, Ferrari Louis, Glenn Kelli J
SK Life Science, Inc, Paramus, NJ, USA.
Expert Opin Pharmacother. 2025 Jul;26(10):1177-1189. doi: 10.1080/14656566.2025.2517352. Epub 2025 Jun 11.
The process of diagnosing patients with epilepsy and selecting the optimal drug remains a significant challenge. Broad-spectrum antiseizure medications (ASMs) treat focal and generalized seizures without worsening other seizure types, making them the drug of choice when the exact seizure classification for patients is unknown. Cenobamate, an ASM approved for the treatment of adult focal seizures, has demonstrated strong efficacy, including high rates of seizure freedom. Evidence suggests that cenobamate has potential to be a broad-spectrum ASM.
Considerations for the selection of broad- versus narrow-spectrum ASMs are discussed and an overview of preclinical, clinical, and real-world evidence relating to cenobamate as a potential broad-spectrum ASM is presented.
Combined evidence from preclinical data, clinical study data, and real-world evidence may indicate that cenobamate may be a broad-spectrum ASM. Evidence is accumulating regarding the utility of cenobamate in treating primary generalized tonic-clonic (PGTC) and seizures associated with developmental epileptic encephalopathies such as Lennox-Gastaut syndrome and Dravet syndrome. Results from the ongoing cenobamate trial in patients with idiopathic generalized epilepsy will determine the efficacy of cenobamate for the treatment of PGTC seizures.
癫痫患者的诊断过程以及选择最佳药物仍然是一项重大挑战。广谱抗癫痫药物（ASMs）可治疗局灶性和全身性癫痫发作，且不会使其他癫痫发作类型恶化，这使其成为患者确切癫痫分类不明时的首选药物。司替戊醇是一种被批准用于治疗成人局灶性癫痫发作的抗癫痫药物，已显示出强大的疗效，包括高癫痫发作缓解率。有证据表明司替戊醇有成为广谱抗癫痫药物的潜力。
讨论了选择广谱与窄谱抗癫痫药物的考量因素，并概述了与司替戊醇作为潜在广谱抗癫痫药物相关的临床前、临床和真实世界证据。
临床前数据、临床研究数据和真实世界证据的综合证据可能表明司替戊醇可能是一种广谱抗癫痫药物。关于司替戊醇在治疗原发性全面强直阵挛发作（PGTC）以及与发育性癫痫性脑病（如伦诺克斯 - 加斯托综合征和德雷维特综合征）相关的癫痫发作方面的效用，证据正在积累。正在进行的司替戊醇治疗特发性全身性癫痫患者试验的结果将确定司替戊醇治疗PGTC癫痫发作的疗效。
