EAN 2026 | Multicentric, real-world, retrospective study evaluating cenobamate in brain tumor-related epilepsy

Brain tumor-related epilepsy is a very challenging condition. Thirty to fifty percent of patients with brain tumors develop epilepsy and the burden is even highest for patients with low-grade gliomas and in enough of these patients, there’s also drug-resistance before tumor surgery. And the choice of the anti-seizure medication in this population is also very difficult because these drugs can exacerbate cognitive and psychiatric symptoms and also cause adverse events. And also there are interactions with anti-seizure medication and some oncological treatments. In the recent year, we have a new drug called cenobamate. It has a novel mechanism of action. In fact, it has a dual mechanism of action. It inhibits persistent sodium currents and also it acts as a positive allosteric modulator of the GABA-A receptor. It has shown unprecedented efficacy in randomized control trials and also effectiveness in the real-world studies and the highest rate of seizure freedom compared to other antiseizure medications for focal epilepsy. And cenobamate has been used now in different focal epilepsies with different etiologies, but there are scarce evidence on the use in brain tumor-related epilepsy. So we conducted a multicentric, real-world, retrospective study on cenobamate as an add-on treatment in patients with brain tumor-related epilepsy. And we included in the study 20 patients with drug-resistant brain tumor-related epilepsy for primary brain tumors. And the baseline median seizure frequency was six, and the patients in 80% of the cases had already undergone surgery. The tumor histologies were heterogeneous, with the most frequent one being meningiomas, followed by astrocytoma and glioblastoma. So in this population, in this cohort of 20 patients, there was a significant reduction in seizure frequency from baseline to the last follow-up, that has a median of 12 months. The rate also of responders was very high with 80% of the patients achieving more than 50% reduction of seizure frequency at the last follow-up and also more than 20% of the patients being seizure-free at the last follow-up available. Another important aspect in this cohort is safety and tolerability. So 60% of the patients had at least one adverse event. The most frequent was somnolence followed by postural instability and in one case there was also mild cutaneous rash. Only in one case an adverse event led to the discontinuation of the drug. It was in the case of the mucocutaneous rash and it resolved after cenobamate discontinuation and overall there was no worsening of psychiatric symptoms or new psychiatric symptoms nor cognitive even if we didn’t perform formal testings. So in this population, in this cohort, cenobamate was very effective and it mirrored what we see for other etiologies, other focal epilepsies from real-world studies and randomized control trials. Regarding safety and tolerability, overall the tolerability was acceptable, but we need, especially for this aspect, studies with larger sample sizes to confirm if cenobamate can be helpful in this population of patients. Thank you.

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