Hogeveen Lara, Legros Benjamin, Meurs Alfred, De Herdt Veerle, Sprengers Mathieu, Hödl Stephanie, Mertens Ann, Gadeyne Stefanie, Raedt Robrecht, Dewaele Frank, Vandersteene Jelle, Boon Paul, Vonck Kristl
4Brain, Department of Neurology, Ghent University Hospital, Ghent, Belgium.
Department of Neurology, HUB-Hôpital Erasme Brussels, Brussels, Belgium.
Eur J Neurol. 2025 Jun;32(6):e70229. doi: 10.1111/ene.70229.
Vagus Nerve Stimulation (VNS) is an effective neuromodulatory treatment for drug-resistant epilepsy (DRE), but many patients still experience uncontrolled seizures. These patients, who are highly refractory, may benefit from novel anti-seizure medications (ASM). This study evaluates the effectiveness of cenobamate (CNB) in patients previously or currently treated with VNS.
We reviewed the medical history of all patients treated with VNS at Ghent University Hospital and HUB-Hôpital Erasme Brussels from 1995 to 2024. Patients who received CNB after ≥ 12 months of VNS therapy were included. Mean monthly seizure frequency was assessed before VNS, after VNS, and post-CNB initiation.
Among 620 patients treated with VNS between March 1995 and November 2023, 54 were additionally treated with CNB after a median VNS duration of 9 years. With VNS, seizure frequency data were available for 52 patients. Of these, 13 (25%) achieved a ≥ 50% reduction in seizure frequency at maximum follow-up, but none became seizure-free. After CNB addition (median dose 200 mg, median follow-up 10 months), 24/54 (44.4%) experienced a ≥ 50% reduction in seizures. 6/54 patients (11.1%) reported seizure freedom for a median of 26 weeks. In 20/54 patients (37%), the number of ASMs was reduced. 7/54 (13%) discontinued CNB because of side effects, with fatigue being the most common, in 23/54 patients (42.6%).
For DRE patients treated with VNS who could benefit from further improvement in seizure control, adding CNB is useful. In our cohort, over one-third of patients experienced a meaningful improvement in seizure frequency with this recently marketed ASM.
迷走神经刺激术（VNS）是治疗药物难治性癫痫（DRE）的一种有效神经调节疗法，但许多患者仍有癫痫发作不受控制的情况。这些高度难治性患者可能会从新型抗癫痫药物（ASM）中获益。本研究评估了司替戊醇（CNB）在既往或目前接受VNS治疗的患者中的有效性。
我们回顾了1995年至2024年在根特大学医院和布鲁塞尔埃拉斯姆斯医院接受VNS治疗的所有患者的病史。纳入在VNS治疗≥12个月后接受CNB治疗的患者。评估VNS治疗前、VNS治疗后以及开始使用CNB后的平均每月癫痫发作频率。
在1995年3月至2023年11月期间接受VNS治疗的620例患者中，54例在VNS治疗中位时长9年后额外接受了CNB治疗。对于VNS治疗，52例患者有癫痫发作频率数据。其中，13例（25%）在最长随访时癫痫发作频率降低≥50%，但无一例无癫痫发作。加用CNB后（中位剂量200mg，中位随访10个月），24/54例（44.4%）癫痫发作减少≥50%。6/54例患者（11.1%）报告无癫痫发作，中位时长为26周。20/54例患者（37%）的抗癫痫药物数量减少。7/54例（13%）因副作用停用CNB，最常见的副作用是疲劳，23/54例患者（42.6%）出现该副作用。
对于接受VNS治疗且有望从癫痫控制的进一步改善中获益的DRE患者，加用CNB是有用的。在我们的队列中，超过三分之一的患者使用这种最近上市的抗癫痫药物后癫痫发作频率有显著改善。
