Cenobamate is one of the latest antiseizure medications (ASMs) developed for the treatment of focal onset seizures in adult patients. Cenobamate is characterized by a peculiar pharmacology. The mechanisms responsible for its anti-seizure activity include enhancement of the inactivated state of voltage-gated sodium channels with blockade of the persistent sodium current and positive allosteric modulation of GABAa receptors at a non-benzodiazepine binding site. Studies showed that cenobamate appears to be an effective treatment for focal epilepsy, showing reductions in seizure frequency, increased responder rates, and high rates of seizure freedom, and is well tolerated and safe. This article reviews the mechanism, pharmacokinetic characteristics, clinical efficacy, and safety of cenobamate as a novel anti-seizure drug
Cenobamate is a new antiseizure medication used in recent years for adult drug-resistant focal epilepsy. Its pharmacological effects have two main features: on the one hand, it can regulate voltage-gated sodium channels, thereby reducing abnormal neuronal excitability; on the other hand, it can act as a positive allosteric modulator of γ-aminobutyric acid-A (GABA-A) receptors and enhance inhibitory neurotransmission. Several existing studies have shown that cenobamate can reduce the frequency of focal seizures and has certain advantages in improving seizure freedom rates. Its common adverse reactions are mainly central nervous system symptoms. At present, the clearest clinical position of cenobamate is still its use in adult drug-resistant focal epilepsy. Its application in children, generalized epilepsy, and special epilepsy syndromes still needs more evidence to support it. This article reviews the pharmacological mechanisms, pharmacokinetics, clinical efficacy, safety, and clinical position of cenobamate, with the aim of providing a reference for its standardized clinical use.