Authors :
Presenting Author: Mar Carreño, MD, PhD – Hospital Clinic Barcelona
Estefanía Conde, MD PhD – Hospital Clínic Barcelona
Marta Olivera, MD – Hospital Clínic Barcelona
Pedro Serrano, MD PhD – Hospital Regional Universitario Málaga
Pablo Cabezudo, MD – Hospital Regional Universitario Málaga
Iratxe Maestro, MD – Centro de Neurología Avanzada Sevilla
Juan Rodríguez Uranga, MD – Centro de Neurología Avanzada
Rosana Saiz, MD – Hospital doce de Octubre Madrid
Dulce Campos, MD – Hospital Clínico Valladolid
Laura Abraira, MD PhD – Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona; Universitat Autonoma de Barcelona, Bellaterra, Spain
Laura Olivie, MD PhD – Fundacion Jiménez Díaz
Marta Marin, MD – Clinica Universitaria Navarra
Mercedes Garces, MD – Hospital la Fe Valencia
Rationale:
Autoimmune epilepsy is uncommon but seizures highly drug resistant. Cenobamate (CNB) is a new generation antiseizure medication (ASM) that has proved to be more efficacious that other ASMs to treat focal epilepsy. Our objective was to describe the efficacy and safety profile of CNB in patients with autoimmune epilepsyMethods:
Multicenter, retrospective, observational study in Spain. Inclusion criteria was confirmed or strongly suspected autoimmune aetiology. We analysed percentage seizure reduction ( >50%, >90% and seizure freedom) at 3 and 6 months and last visit available. We also analysed adverse effects, and comedication reduction. Results:
42 patients -71% female- (6, epilepsy after autoimmune encephalitis; 9, after seronegative autoimmune encephalitis; 13, chronic epilepsy with antibodies without previous encephalitis; 4 epilepsy after NORSE or FIRES; 5, Rasmussen disease; 5, epilepsy related to systemic autoimmune disease). Mean age was 38.3 years. Mean seizure frequency during previous 3 months before CNB was 9.5 seizures/month. Mean epilepsy duration was 11.5 years. Mean number of previously used ASMs was 6. Most frequent antibodies were GAD (19 patients). 15 patients had other systemic autoimmune diseases (6 diabetes, 3 thyroid disease). 13 patients had received immunotherapy in the past, 13 patients were receiving immunotherapy in addition to CNB. 30 patients were taking 3 or more concomitant ASMs (23 took concomitant CLB).
Mean follow up period was 9.9 months. 39.3% of patients had a follow up longer than 6 months. Median CNB dose was 150 (IQR 100) at 3 months, 200mg (IQR 50) at 6 months, and 250 (IQR 100) at last visit. At 3 months, 24/39 patients (61.5%) experienced ³ 50% seizure frequency reduction, 8/39 (20.5%) ³ 90% seizure frequency reduction, and 3/39 (7.7%) patients were seizure free. At 6 months, 22/33 patients (66.7%) had ³ 50% seizure frequency reduction, 10/33 (30.3%) had ³ seizure frequency reduction, and 5/33 (15.1%) were seizure free. At last visit 2/30 (6.7%) were seizure free and 15/30 (50%) had 90% seizure frequency reduction. Almost 50% of patients had at least one concomitant ASM discontinued during follow up.
Adverse effects were present in 20 (71.42%) patients at 3 months, 13 (50%) at 6 months and 4 (36,36%) at last visit, mainly somnolence, dizziness and ataxia. AE at 3 and 6 months were more common in patients taking concomitant sodium channel blockers or clobazam.
Conclusions:
CNB seems a promising option to treat drug resistant autoimmune epilepsy, with similar efficacy and tolerability to those reported in focal epilepsies of other etiologies. Funding: No funding