To evaluate the safety and efficacy of adding CNB for treating drug-resistant focal-onset seizures.

Cenobamate (CNB) is an anti-seizure medication (ASM) utilized for drug-resistant focal-onset seizures, which are difficult to manage with usual agents. Previous studies demonstrated that it can be effective in patients with refractory epilepsy.

MEDLINE, Scielo, and Scopus databases were searched for studies comparing the efficacy of CNB as an add-on therapy to placebo or another ASM in patients with refractory focal epilepsy. A Random-effects model was employed to compute the Mean Difference (MD) and the Risk Ratio (RR) with 95% Confidence Intervals (CI). Statistical Analyses were performed utilizing RStudio 4.4.1.

A total of four studies were included, comprising 912 patients; 524 (57%) received CNB as add-on therapy. The results indicated that the percentage change in seizure frequency (MD -30.497; 95% CI -44.213 to -16.780; p < 0.001; I² = 12%) and the fifty percent responder rate (RR 1.902; 95% CI 1.289 to 2.807; p = 0.001; I² = 80%) were significantly higher in this group. Adverse events such as balance disorder (RR 9.184, 95% CI 1.755 to 48.072; p < 0.009; I² = 0%) and nystagmus (RR 9.207; 95% CI 1.800 to 47.098; p = 0.008; I² = 0%) were statistically significant in this one.

 In this meta-analysis of four studies, CNB as an add-on therapy significantly reduced seizure frequency in patients with drug-resistant focal seizures, making it a promising option for improved seizure control and quality of life.