Abstract Details

Title The Effect of Cenobamate on Responsive Neurostimulation Epileptiform Events

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 9-011

Objective To assess cenobamate’s effect on the number of electrocorticographic (ECoG) events recorded by responsive neurostimulation (RNS).

Background

RNS ECoG data have been used as a potential method to assess efficacy following new add-on antiseizure medications (ASMs).

Design/Methods This retrospective, multicenter, observational, 24-week study included adults (≥18 years) with a history of recurrent focal seizures and implanted RNS who initiated adjunctive cenobamate ≥3 months after RNS implant between 4/1/2020-12/15/2023. Patients who received ≥2 weeks of cenobamate treatment at a minimum dose of 50 mg/day were enrolled. RNS-detected events (RDE) obtained from NeuroPace PDMS were reviewed to select only epileptiform events (EEs) based on electrographic ictal patterns. RDEs and EEs were counted during the 8-week baseline period, every 2 weeks for 12 weeks after starting cenobamate, and at study end. The primary outcome was the change in the number of EEs from baseline to the last treatment period observation (12+ weeks). Patient-reported clinical seizure frequency was recorded when available.

Results Thirty-seven patients (mean age 36.7 years) were included. Median cenobamate (range) dose was 150 (50-250) mg/day. EE numbers were significantly reduced from baseline (mean 15.7 per 28 days) to last observation (mean 2.5 per 28 days; P<0.001). Likewise, EE numbers >50 seconds (P<0.001) were significantly reduced. Among 25 patients with clinical seizure data, median clinical seizure frequency per 28 days decreased from 2.5 to 0.75 post-treatment. Dizziness and lethargy were the most commonly reported adverse events during cenobamate treatment; these resolved with slower titration and/or reductions in concomitant ASMs.

Conclusions Patients with uncontrolled seizures after RNS had a significant reduction in EEs (including EEs >50 seconds) and a numerical reduction in clinically reported seizures during adjunctive cenobamate treatment. Results from this analysis support the potential use of RNS ECoG data as an objective measure to assess the efficacy of cenobamate and possibly other adjuvant ASMs.

Authors/Disclosures
Sami M. Aboumatar, MD (Austin Epilepsy Care Center) PRESENTER	Dr. Aboumatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Aboumatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for SK Life Science, Inc.. Dr. Aboumatar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Aboumatar has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sunovion.
Jay Gavvala, MD (UT Health Houston Department of Neurology)	The institution of Dr. Gavvala has received research support from NIH.
Zeenat Jaisani, MD (University of Alabama At Birmingham)	Dr. Jaisani has nothing to disclose.
Ruben I. Kuzniecky, MD, FAAN	Dr. Kuzniecky has nothing to disclose.
Michael D. Privitera, MD, FAAN (Univ of Cincinnati/Dept of Neurology)	Dr. Privitera has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for SK life science. Dr. Privitera has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NeuroPace. Dr. Privitera has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK life science. Dr. Privitera has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Jazz. The institution of Dr. Privitera has received research support from Neurelis. The institution of Dr. Privitera has received research support from Biohaven. Dr. Privitera has received research support from Neurava.
Madeline Ring, MD	Dr. Ring has nothing to disclose.
Eric Heidel, PhD	Dr. Heidel has nothing to disclose.
William E. Rosenfeld, MD, FAAN (Comprehensive Epilepsy Care Center for Children and Adults)	The institution of Dr. Rosenfeld has received personal compensation in the range of $500,000-$999,999 for serving as a Consultant for SK Life Science. Dr. Rosenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Speakers Bureau for SK Life Science.
Jacob Pellinen, MD (University of Colorado)	The institution of Dr. Pellinen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for SK Life Science. The institution of Dr. Pellinen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz Pharmaceuticals.

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