Highlights
- •Assessment of cognition before and during adjunctive treatment with cenobamate.
- •Most patients showed stable or improved cognitive performance (EpiTrack).
- •Cognitive change was not associated with cenobamate dose.
Abstract
Purpose
Cenobamate (CNB) is a new antiseizure medication (ASM) for the treatment of focal
epilepsy in adults. While efficacy of CNB was confirmed in controlled clinical trials,
its effects on cognition are unclear. Cognitive adverse effects of ASM affect quality
of life and retention rate. Therefore, we investigated whether the adjunctive treatment
with CNB is associated with changes in cognitive performance.
Method
Efficacy and tolerability of CNB were investigated in an observational study. Fifty
patients with pharmacoresistant focal epilepsy aged 18 to 71 years (Mdn = 37.5 years)
were tested before (T0) and after reaching the first target dose of CNB, usually after
three months (T1). Cognitive performance was assessed using the EpiTrack©, a change-sensitive
screening tool for attention and executive functions.
Results
The median CNB dose at T1 was 125 mg/day (range: 50 – 250 mg/day). Most patients received
2–3 concomitant ASMs. Individual test scores remained stable in 72%, significantly
improved in 16%, and significantly deteriorated in 12% of the patients from T0 to
T1. The total group showed a significant improvement in EpiTrack scores (p < .01). Changes in EpiTrack performance from T0 to T1 occurred independently of CNB
dose, changes in the total drug load or reduction in seizure frequency.
Conclusion
Most of the patients showed stable or improved cognitive performance. Thus, there
is preliminary evidence that adjunctive CNB is not associated with an increased risk
of cognitive side effects for the majority of patients. These findings need to be
confirmed in controlled trials encompassing higher doses.
Keywords
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Article info
Publication history
Published online: October 04, 2022
Accepted:
October 3,
2022
Received in revised form:
August 29,
2022
Received:
July 7,
2022
Identification
Copyright
© 2022 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
