Cenobamate is an effective treatment for drug resistance focal epilepsy: a critical review

Abstract

Abstract Cenobamate, recently approved anticonvulsant by the Food and Drug Administration (FDA), stands as a potential remedy for drug-resistant epilepsy (DRE). It shows promise in enhancing seizure management efficacy. An in-depth analysis of various literature sources, encompassing clinical trials, preclinical investigations, and pharmacokinetic evaluations, assesses cenobamate’s safety, and effectiveness. The focus lies in its supplementary role for DRE treatment and its advantages for challenging patient groups. Cenobamate operates through a dual mechanism of action, selectively curtailing persistent sodium currents and positively influencing Gamma-aminobutyric acid (GABA) receptors to hinder seizure initiation and spread. Pharmacokinetic studies reveal swift absorption, dose-dependent effects, and the necessity for tailored dosing approaches. Clinical trials demonstrate enhanced seizure control linked to escalating doses, notably at 200 and 400 mg, though lower doses might encounter response and tolerance hurdles. Safety evaluations indicate predominantly mild to moderate adverse events, with rare occurrences of hypersensitivity reactions. Moreover, cenobamate demonstrates significant interactions with other drugs, necessitating adjustments in dosages for certain concurrent antiseizure medications. Cenobamate emerges as a hopeful therapeutic avenue for DRE, offering optimism to patients grappling with insufficient seizure control. Understanding its mechanisms, pharmacokinetics, and personalized dosing is crucial for optimal clinical outcomes. While managing drug interactions poses challenges, cenobamate signifies substantial progress in meeting the needs of individuals facing challenging focal epilepsy. Ongoing research and clinical insights will refine its role, ultimately advancing epilepsy care.