Cenobamate Provides Significant Reduction in Seizure Activity in Patients with Infantile Spasms
Abstract number :
1.425
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2024
Submission ID :
1360
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Rajesh Sachdeo, MD – Jersey Shore University Medical Center, Hackensack Meridian Health System
Richard Sultan, MD – Jersey Shore Medical Center
Rationale: Cenobamate is an antiseizure medication currently approved for patients with focal
epilepsy 18 years of age and older. Ongoing studies are being performed for children with focal
seizures and for adolescents with generalized epilepsy. Off-label reports have been published
with pediatric patients with focal epilepsy as well as with various seizure syndromes including
Lennox - Gastaut and Dravet syndromes. Here, we report 6 cases of infantile spasms
treated with cenobamate.
Methods: A chart review of pediatric patients with infantile spasms who have been treated with
cenobamate was performed in a busy pediatric patient practice. All patients had previously been
treated unsuccessfully with ACTH and vigabatrin (gold standard of therapy for such patients) as
well as with other antiseizure medications including valproate, felbamate, clobazam, topiramate,
phenobarbital and others.
Results: There were 6 pediatric patients ages 22 months to 5 years old who had been treated
with cenobamate. Every patient had been tried on at least 6 and some up to 11 antiseizure
medications before treatment with cenobamate. Five patients have been taking cenobamate for 6
months or longer with a mean dosage of cenobamate of 50 mg (range 25 mg to 100 mg). There
was greater than 50% reduction in seizure frequency and 2 patients were seizure free at the last
visit. The total drug load on all patients was reduced with one patient currently on cenobamate
monotherapy. One patient is on cenobamate with valproate and 3 patients on cenobamate with
felbamate. In one patient, despite a good therapeutic response, cenobamate was discontinued
because of increasing cortisol levels. Apart from seizure reduction, EEGs in all patients showed
marked reduction in spike load.
Conclusions: Cenobamate appears to be a helpful treatment for patients with infantile spasms as
evidenced by considerable reductions in seizure activity and improvement in EEGs. In our
opinion, cenobamate should be considered when treatment with ACTH /steroids and vigabatrin
is unsuccessful. By controlling seizures and spike load earlier in the disease, the risk of
developmental cognitive delay will be reduced. Long term follow-up of these patients will be
helpful and a larger study or compilation of infantile spasm patients should be performed.
Funding: none
Anti-seizure Medications