Abstract
Medical management of epilepsy seeks to eliminate or to reduce the frequency of seizures, help patients maintain a normal lifestyle, and maintain psychosocial and occupational activities, while avoiding the negative side effects of long-term treatment. Current FDA approved drugs have been shown to have similar efficacy; however, they all share a commonality of having side effects that have the potential to significantly reduce a patient’s quality of life. Cenobamate, a newly-FDA approved drug used to treat partial-onset seizures in adult patients, has demonstrated promise in that it works on two proposed mechanisms that are commonly associated with epilepsy. Cenobamate acts as a positive allosteric modulator of the GABAA ion channels and is effective in reducing repetitive neuronal firing by inhibition of voltage-gated sodium channels, although the complete mechanism of action is currently unknown. The efficacy of Cenobamate with its low toxicity and adverse drug reaction profile emphasizes the need to further evaluate antiepileptic therapies containing sulfamoylphenyl and/or carbamate moieties in their chemical structure. Recent studies have found more patients to be seizure free during the maintenance period when compared to placebo. The most common side effects reported in with Cenobamate are somnolence, dizziness, headache, nausea, and fatigue. There are currently ongoing phase III studies looking to further evaluate the long-term benefits of Cenobamate and investigate adverse events.
Highlights
Seizure is often classified and further subclassified to describe paroxysmal events of sudden onset neuronal firing resulting in a short period of altered neurologic function
Cenobamate acts as a positive allosteric modulator of the GABAA ion channels and is effective in reducing repetitive neuronal firing by inhibition of voltage-gated sodium channels, but the complete mechanism of action is currently unknown
The results demonstrated a 1.5-fold increase in area under the curve (AUC) for mild to moderate renally impaired (RI) individuals, a 2-fold increase in AUC for mild to moderate hepatic impaired (HI) individuals, and no clinically significant findings were found between elderly and young individuals [37]
Summary
Seizure is often classified and further subclassified to describe paroxysmal events of sudden onset neuronal firing resulting in a short period of altered neurologic function. There are many causes for seizures and seizure mimicking events such as syncope, migraine, stroke, and psychogenic nonepileptic seizures. After ruling out seizure mimickers, the management of a new-onset, single seizure is driven by the determination of the underlying cause. Seizures can result from an external cause (e.g., nonepileptic) or an intrinsic dysfunction of the central nervous system. A baseline metabolic evaluation should be done to evaluate the cause of a new seizure. An initial evaluation should determine the likelihood that a patient will have additional seizures, assist in the decision whether to begin antiseizure drug therapy, and direct appropriate treatment to the underlying cause, if identified. Systemic process is ruled out, as well as any treatable underlying brain pathology, the identification of factors that increase the likelihood of recurring seizures is often made.
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