Neurol. praxi. 2025;26(4):338-341 | DOI: 10.36290/neu.2025.061

What options do anti-seizure medications provide us today?

MUDr. Dana Vyskočilová

Neurologická klinika 3. LF UK a Thomayerovy nemocnice, Praha

Cenobamate (CNB) is a third generation anti-seizure medication with a dual mechanism of action indicated for the adjunctive treatment of focal-onset seizures in adult patients with epilepsyinadequately controlled despite prior treatment with at least two anti-seizure drugs. In therapeutic doses, it most likely acts through positive allosteric modulation of γ-aminobutyric acid type A (GABAA) receptors at the non-benzodiazepine binding site, as well as preferential inhibition of persistent sodium currents and enhancement of the deactivated state of voltagegated sodium channels. Numerous clinical experiences with cenobamate testify to its high e ectiveness in terms of achieving seizure freedom, even in patients who are still drug-resistant. At the same time, CNB appears to be a well tolerated drug with a minimum of adverse events, even in elderly patients. However, attention must be paid to potential pharmacokinetic and pharmacodynamic interactions and gradual titration when starting treatment. It is contraindicated in patients with a rare familial occurrence of a short QT interval. Its recommended dosage is 200- 400 mg/ d taken in one daily dose. The article presents two case reports from the practice of the epileptology outpatient clinic of FTN Prague.

Keywords: epilepsy, cenobamate, adjunctive treatment, elderly patient.

Accepted: August 5, 2025; Prepublished online: August 5, 2025; Published: September 29, 2025  Show citation