To report the effectiveness and safety of cenobamate during routine clinical practice in patients with uncontrolled focal seizures living in a group home or with a developmental disability.

Cenobamate is approved in the US for treatment of focal seizures in adults.

Twenty-eight adults (16 male/12 female; mean age 38.4 years, range 19-64) with uncontrolled focal seizures despite taking stable doses of ≥2 antiseizure medications (ASMs) receiving adjunctive cenobamate in routine clinical practice were included in this medical record review.

Mean seizure frequency in the 2-3 months before starting cenobamate was 20.9 seizures/month (median=3.5); 53.6% of patients were receiving ≥4 ASMs at cenobamate initiation. Reported seizures included focal impaired awareness (n=11), focal aware motor (n=2), and focal to bilateral tonic-clonic (FBTC) (n=16; 1 patient had both focal impaired awareness and FBTC seizures). Mean seizure frequency/month decreased from 20.9 to 4.1 following 5-6 months of treatment. Responder rates of ≥50%, ≥75%, ≥90%, and 100% seizure reduction occurred in 92.6%, 81.5%, 55.6%, and 48.2% of patients at months 5-6 of cenobamate treatment. Mean cenobamate dose at 6 months was 156.7 mg/day (range 50-300). Adverse events (AEs) were reported in 9 patients (32.1%): dizziness (n=4; 3 resolved with lowered lacosamide); drowsiness (n=3; all resolved with lowered brivaracetam, clobazam, or clonazepam); ataxia (n=2; 1 resolved with lowered clobazam); and acting out (n=1; resolved with lowered clobazam). Two patients discontinued cenobamate prior to month 5 due to dizziness and ataxia, respectively. Dose reductions were most common with lacosamide (n=10; median reduction=47.0%), clobazam (n=5; 100.0%), lamotrigine (n=4; 43.8%), and perampanel (n=3; all 100%). 

Patients living in a group home or with developmental disability experienced substantial reduction in focal seizure frequency and high responder rates, including seizure freedom, with adjunctive cenobamate. Treatment was well tolerated; AEs were often mitigated or resolved following reduction of concomitant ASMs.