Cenobamate Efficacy in Medically Refractory Epilepsy Patients Using Clinical and RNS Biomarkers
Abstract number :
1.274
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2024
Submission ID :
1048
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Wasan Abd Wahab, MD – Yale School of Medicine
Tuan Bui, BS – Yale School of Medicine
Anthony Jimenez, BS – Yale University School of Medicine
Lawrence Hirsch, MD – Yale University School of Medicine
Imran Quraishi, MD, PHD – Yale School of Medicine
Rationale:
Approximately one-third of patients with epilepsy fail to achieve long-term seizure control with existing medications, and each additional drug trial reduces the likelihood of attaining seizure freedom. Treatment decisions are often guided by subjective seizure reports, making accurate seizure tracking challenging. The Responsive Neurostimulation (RNS) System offers a method to objectively monitor seizures, potentially enhancing the accuracy of seizure tracking1. The efficacy of combining RNS with newer medications like cenobamate is not known.
Methods: This study aims to assess the impact of cenobamate on seizure frequency and objective biomarkers in patients with RNS. We gathered clinical and device data from patients with RNS prescribed cenobamate. Clinical responses were assessed through patient reports, while electrographic responses were evaluated using RNS data, including long episodes (patterns sustained beyond a patient-specific threshold, often correlating with seizures, typically 20-30 sec) and total detections of epileptiform activity. These biomarkers were compared across response groups: super-responders (≥90% improvement), intermediate responders (≥50% improvement), and non-responders (< 50% improvement).
Results: We identified 22 medically refractory patients seen between November 1, 2019, to February 29, 2024, who had RNS and were prescribed cenobamate. Four patients were excluded: three due to cenobamate starting prior to RNS implantation and one for early discontinuation of cenobamate due to adverse effects. The remaining 18 patients had failed an average of 8 anti-seizure medications. Reported cenobamate benefit was noted in 11/18 patients, including 7 super-responders and 5 intermediate responders. A significant reduction in total detections (p<0.05, Wilcoxon signed rank test) after reaching steady dose of cenobamate, as compared with pre-cenobamate baseline, was seen in 6/7 super-responders, 4/5 intermediate responders, and only 1/6 non-responders. Similarly, significant reduction in long episodes after reaching a steady dose was seen in 4/7 super-responders, 2/5 intermediate responders, and 0/6 non-responders. Reduction in either of these biomarkers was associated with clinical response (p= 0.0128, Fisher Exact Test).v
Neurophysiology