Plaquevent Antoine, Goff Floriane Le, Chastan Nathalie
Neurophysiologie, Centre Hospitalier Universitaire de Rouen, 1 Rue de Germont, 76031 ROUEN, France.
Neurologie, Centre Hospitalier Universitaire de Rouen, 1 Rue de Germont, 76031 ROUEN, France.
Epilepsy Behav Rep. 2025 Jun 2;31:100782. doi: 10.1016/j.ebr.2025.100782. eCollection 2025 Sep.
Epilepsy is a common and disabling neurological disorder. To significantly improve the quality of life of patients, the primary goal is to achieve seizure freedom. Unfortunately, 30 % of epilepsies are drug-resistant and seizure freedom is not acheived. Cenobamate is a new anti-seizure medication (ASM) used as a treatment for focal epilepsy in adults whose seizures have not been able to be controlled by two prior ASM. Two previous pivotal studies have showed an unusual seizure-free rate at 21 % and 28 %. A retrospective observational study was conducted to determine the effectiveness, safety and retention of cenobamate in 87 patients with highly focal drug-resistant epilepsy. The responder rate was 48 % with a seizure-free rate of 18 % at the last follow-up, with a mean dose of cenobamate at 216 mg. Adverse events were reported in 74 % patients, the most frequent being somnolence/fatigue and dizziness. No cases of DRESS or death were reported during the study. Cenobamate was discontinued in 34 % of patients, for a lack of efficacy despite an adequate dosage (≥ 200 mg) in 30 %, a poor tolerance in 27 %, for both insufficient efficacy and poor tolerance in 40 %, or for pregnancy plans in 3 %. Cenobamate is an effective and well-tolerated ASM in drug-resistant focal epilepsy and should be tried for highly drug-resistant epilepsy, even if many previous ASM have failed. Moreover, the impressive seizure-free rate leads to introducing cenobamate to all patients before or during the evaluation for surgical candidacy, and in any case before any resective surgery.
癫痫是一种常见的、使人致残的神经系统疾病。为显著提高患者的生活质量，首要目标是实现无癫痫发作。不幸的是，30%的癫痫患者存在耐药性，无法实现无癫痫发作。司替戊醇是一种新型抗癫痫药物（ASM），用于治疗成人局灶性癫痫，这些患者之前使用两种ASM均无法控制癫痫发作。之前的两项关键研究显示无癫痫发作率分别为21%和28%，这一比例不同寻常。一项回顾性观察研究旨在确定司替戊醇对87例高度局灶性耐药癫痫患者的有效性、安全性和耐受性。缓解率为48%，最后一次随访时无癫痫发作率为18%，司替戊醇的平均剂量为216毫克。74%的患者报告了不良事件，最常见的是嗜睡/疲劳和头晕。研究期间未报告药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）或死亡病例。34%的患者停用了司替戊醇，其中30%是因为尽管剂量充足（≥200毫克）但缺乏疗效，27%是因为耐受性差，40%是因为疗效不佳和耐受性差，3%是因为妊娠计划。司替戊醇在耐药局灶性癫痫中是一种有效且耐受性良好的ASM，即使之前多种ASM治疗均失败，对于高度耐药癫痫也应尝试使用。此外，令人印象深刻的无癫痫发作率促使在评估手术候选资格之前或期间，甚至在任何切除性手术之前，就将司替戊醇用于所有患者。
