- Design
- Multicentre retrospective cohort with propensity-matched comparison
- Population
- 31 adults with focal refractory or super-refractory status epilepticus, Spain
- Primary outcome
- Sustained status termination (>24 h) attributable to cenobamate
- Effect
- 83.9% overall; matched resolution 82.1% vs 57.1%, adjusted OR 5.9 (1.2–30)
A multicentre Spanish registry identified 31 adults with focal-onset refractory or super-refractory status epilepticus treated with cenobamate between 2022 and 2025. Cenobamate was started a median of four days after onset, after a median of five failed antiseizure drugs, at a median starting dose of 50 mg daily.
Sustained termination of status for more than 24 hours, judged attributable to cenobamate, occurred in 84% — all 17 with refractory status and 64% of those with super-refractory status — after a median of two days. In a propensity-matched comparison with 56 registry controls, resolution was 82% against 57% (adjusted OR 5.9). Somnolence was the commonest side effect; no serious drug-related events were recorded.
This is a small retrospective series, which the authors rate as Class IV evidence, and attributing resolution to one drug among many is difficult. Cenobamate's slow titration — required to reduce the DRESS risk seen with rapid escalation — limits how fast it can be pushed. It is a reasonable option to discuss in focal status that has resisted standard agents, not a new standard.
- Consider cenobamate as an adjunct in focal refractory status epilepticus after standard agents have failed.
- Start low, as in this series, rather than escalating quickly.
- Watch for somnolence and for rash or fever suggesting hypersensitivity.
- Check availability and cost locally; access in India may be limited.
Why it matters
Few options exist once several antiseizure drugs have failed, and this one is enteral rather than requiring deeper anaesthesia.
Don't overread it
With 31 patients and a retrospective design, it cannot show cenobamate caused the seizures to stop.
The statistics, in plain English
An adjusted OR of 5.9 with an interval from 1.2 to 30 shows a strong association but huge uncertainty about its size, as expected with 28 exposed patients. Matching on registry data cannot remove differences clinicians acted on when choosing the drug.
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