Cenobamate is the newest AED that works by modulating GABA_A receptors and reducing repetitive neuronal firing by inhibiting voltage-gated Na+ channels¹. A randomized double-blind trial determined 50% responder-rate for Cenobamate of 50.4% and seizure freedom rate of 28.3%². To avoid potential side effects, 12-week titration was recommended^3.

58 patients were identified; 4 excluded due to age (<18). Records of 54 patients (median age 33, range 18-68) were reviewed.

At the dose of 50mg, 12.5% of patients reported seizure freedom. At 100mg, 50% of patients reported seizure freedom and 25% of patients had 50% seizure reduction. At the dose of 200mg, 33% of patients were seizure free and 81% had seizure reduction of ≥50%. 

Most common side effects were drowsiness (37%), imbalance (26%), fatigue (24%), and dizziness (20%). Two patients reported a rash (4%).

For drowsiness, the most common concurrent AEDs included Clobazam (76%), Brivaracetam (47%), CBD (41%), and Lacosamide (41%). For imbalance: Clobazam (75%), CBD (50%), Brivaracetam (42%), and Lamotrigine (33%).

Majority of patients experienced improvement in adverse effects when doses of concurrent AEDs were lowered.

There seems to be a pharmacodynamic interaction of Cenobamate with certain medications, such as Brivaracetam/Levetiracetam, which implies an interaction with a mechanism involving SV2A ligand binding and/or its physiological effects.