Cenobamate Shows Stronger Real-World Seizure Control

Large retrospective analysis highlights differences in seizure control, retention, and adverse effects among newer agents

By
Henry Thomas
March 4, 2026
2 min

Conexiant

Objective:

To compare the effectiveness, retention, and tolerability of cenobamate with brivaracetam, lacosamide, and perampanel in patients with drug-resistant focal epilepsy.

Approach:

Key Findings:

Cenobamate showed significantly higher odds of achieving a 50% or greater reduction in seizure frequency at 6 and 12 months compared to all three comparators.
Cenobamate had higher seizure-freedom rates than brivaracetam and perampanel at 12 months.
Treatment retention at 12 months was higher for cenobamate compared to brivaracetam and perampanel, and comparable to lacosamide.
Cenobamate was associated with the highest incidence of adverse effects, primarily somnolence and dizziness.

Interpretation:

Cenobamate appears to provide superior seizure control in real-world settings despite a higher incidence of adverse effects, suggesting it may be a preferred option for patients with more refractory epilepsy.

Limitations:

Retrospective design limits causal inference.
Lack of head-to-head randomized trials among newer agents.

Conclusion:

Large adjusted real-world analyses like CREW can inform treatment sequencing in focal epilepsy, but prospective studies are needed to clarify patient selection for agents like cenobamate.