Abstract Details

Title Delayed and Deferred Surgery Associated with Cenobamate Use in People with Drug Resistant Focal Epilepsy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 11-002

Objective

To evaluate whether surgery was obtained within 12 months for patients who received cenobamate as a treatment during the presurgical evaluation and those who did not, comparing across years before and after cenobamate approval at a single center.

Background Cenobamate is a highly effective antiseizure medication for patients with focal epilepsy, including those being considered for epilepsy surgery. Prior recommendations have suggested some of this population may be able to avoid surgery.

Design/Methods

Patients undergoing surgical evaluation for drug resistant focal epilepsy at the University of Colorado during 2018 and 2023 who had at least 12 months of follow up data were analyzed. Comparison years allowed analysis of 12 months follow up and avoiding the confounding effect of COVID-19 pandemic on surgical volume, while comparing times before and after cenobamate’s FDA approval. The primary outcome (surgery within 12 months) was modeled with potential explanatory variables using multiple logistic regression. A p-value of <.05 was considered significant.

Results After controlling for potentially confounding variables, cenobamate use during the pre-surgical evaluation period was associated with an estimated 87% decrease in the odds of surgery within 12 months compared to not being prescribed this medication (odds ratio = 0.13, 95% CI 0.04 to 0.42, p < 0.001) (Figure 1). Being Hispanic or Latino was associated with an estimated 77% decrease in the odds of surgery within 12 months (odds ratio = 0.23, 95% CI 0.09 to 0.61, p < 0.01). Year of evaluation (2023 vs 2018), education level, age, and sex, did not have significant independent associations with undergoing surgery within 12 months.

Conclusions

Patients with drug resistant focal epilepsy undergoing evaluation for epilepsy surgery may benefit from cenobamate. The delay-to-surgery identified among Hispanic and Latino patients suggests potential barriers to care warranting further investigation.

Authors/Disclosures
Louis Ferrari (SK Lifescience) PRESENTER	Louis Ferrari has received personal compensation for serving as an employee of 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.
Stefan Sillau	Stefan Sillau has nothing to disclose.
Aimee Bui, OMS-III	Miss Bui has nothing to disclose.
Alexandra D. Danciutiu, BS	Miss Danciutiu has nothing to disclose.
Lesley Kaye, MD (Department of Neurology, CU Anschutz Medical Campus)	The institution of Dr. Kaye has received research support from NeuroPace. The institution of Dr. Kaye has received research support from LivaNova.
Ashvin Sood, MD	Dr. Sood 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.
Christopher Elder, MD	Dr. Elder has received personal compensation in the range of $500-$4,999 for serving as a Consultant for SK Life Science Inc.. Dr. Elder has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Science Inc.. Dr. Elder has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Neurology and Neuroscience Reports.

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