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Abstract：
OBJECTIVE: Cenobamate is an antiseizure medication (ASM) associated with high rates of seizure freedom and acceptable tolerability in patients with focal seizures. To achieve the optimal cenobamate dose for maximal potential effectiveness while avoiding or minimizing drug-related adverse events (AEs), the administration of cenobamate with other ASMs must be managed through concomitant ASM load reduction. A panel of Spanish epilepsy experts aimed to provide a Spanish consensus on how to adjust the dose of concomitant ASMs in patients with drug-resistant epilepsy (DRE) in order to improve the effectiveness and tolerability of adjunctive cenobamate.
METHODS: A three-stage modified Delphi consensus process was undertaken, including six Spanish epileptologists with extensive experience using cenobamate. Based on current literature and their own expert opinion, the expert panel reached a consensus on when and how to adjust the dosage of concomitant ASMs during cenobamate titration.
RESULTS: The expert panel agreed that tailored titration and close follow-up are required to achieve the best efficacy and tolerability when initiating cenobamate in patients receiving concomitant ASMs. When concomitant clobazam, phenytoin, phenobarbital, and sodium channel blockers are taken at high dosages, or when the patient is receiving two or more sodium channel blockers, dosages should be proactively lowered during the cenobamate titration period. Other concomitant ASMs should be reduced only if the patient reports a moderate/severe AE at any stage of the titration period.
CONCLUSIONS: Cenobamate is an effective ASM with a dose-dependent effect. To maximize effectiveness while maintaining the best tolerability profile, co-medication management is needed. The recommendations included herein provide practical guidance for proactive and reactive management of co-medication in cenobamate-treated patients with DRE and a high drug load.
CONCLUSIONS: Patients with epilepsy may continue to have seizures even after treatment with several different antiseizure medications (ASMs). Cenobamate is an ASM that can reduce seizures in these patients. In this study, six Spanish experts in epilepsy discussed the best way to use cenobamate in drug-resistant epilepsy. They provide practical guidance on when and how the dose of other ASMs might be adjusted to reduce side effects and optimize the use of cenobamate.
METHODS: A three-stage modified Delphi consensus process was undertaken, including six Spanish epileptologists with extensive experience using cenobamate. Based on current literature and their own expert opinion, the expert panel reached a consensus on when and how to adjust the dosage of concomitant ASMs during cenobamate titration.
RESULTS: The expert panel agreed that tailored titration and close follow-up are required to achieve the best efficacy and tolerability when initiating cenobamate in patients receiving concomitant ASMs. When concomitant clobazam, phenytoin, phenobarbital, and sodium channel blockers are taken at high dosages, or when the patient is receiving two or more sodium channel blockers, dosages should be proactively lowered during the cenobamate titration period. Other concomitant ASMs should be reduced only if the patient reports a moderate/severe AE at any stage of the titration period.
CONCLUSIONS: Cenobamate is an effective ASM with a dose-dependent effect. To maximize effectiveness while maintaining the best tolerability profile, co-medication management is needed. The recommendations included herein provide practical guidance for proactive and reactive management of co-medication in cenobamate-treated patients with DRE and a high drug load.
CONCLUSIONS: Patients with epilepsy may continue to have seizures even after treatment with several different antiseizure medications (ASMs). Cenobamate is an ASM that can reduce seizures in these patients. In this study, six Spanish experts in epilepsy discussed the best way to use cenobamate in drug-resistant epilepsy. They provide practical guidance on when and how the dose of other ASMs might be adjusted to reduce side effects and optimize the use of cenobamate.
摘要：
目的：Cenobamate是一种抗癫痫药物（ASM），与局灶性癫痫发作患者的高癫痫发作自由率和可接受的耐受性相关。为了在避免或最小化药物相关不良事件（AE）的同时实现最大潜在有效性的最佳西诺本剂量，必须通过降低ASM负荷来管理与其他ASM的西诺本的给药。西班牙癫痫专家小组旨在就如何调整耐药癫痫（DRE）患者合并ASM的剂量提供西班牙共识，以提高辅助性cenobamate的有效性和耐受性。
方法：进行了三阶段改进的德尔菲共识过程，包括六位西班牙癫痫学家，他们有丰富的使用西诺巴酸盐的经验。根据目前的文献和他们自己的专家意见，专家小组就在西伯那酸滴定过程中何时以及如何调整伴随ASM的剂量达成了共识.
结果：专家小组一致认为，在接受合并ASM的患者中，当开始使用西诺巴坦时，需要量身定制的滴定和密切随访以达到最佳疗效和耐受性。苯妥英,苯巴比妥,钠通道阻滞剂是高剂量服用的，或者当患者接受两种或多种钠通道阻滞剂时，在锡萘酯滴定期间，应主动降低剂量。仅当患者在滴定期的任何阶段报告中度/重度AE时，才应减少其他伴随的ASM。
结论：西诺巴特是一种有效的ASM，具有剂量依赖性作用。为了最大限度地提高疗效，同时保持最佳的耐受性，需要共同用药管理。本文中包含的建议为接受西诺本治疗的DRE和高载药量患者的联合用药的主动和反应性管理提供了实用指导。
结论：癫痫患者即使在使用几种不同的抗癫痫药物（ASM）治疗后也可能继续发作。Cenobamate是一种ASM，可以减少这些患者的癫痫发作。在这项研究中,西班牙的六位癫痫专家讨论了在耐药性癫痫中使用西诺本酸盐的最佳方法。它们提供了关于何时以及如何调整其他ASM的剂量以减少副作用并优化西伯坦的使用的实用指导。
方法：进行了三阶段改进的德尔菲共识过程，包括六位西班牙癫痫学家，他们有丰富的使用西诺巴酸盐的经验。根据目前的文献和他们自己的专家意见，专家小组就在西伯那酸滴定过程中何时以及如何调整伴随ASM的剂量达成了共识.
结果：专家小组一致认为，在接受合并ASM的患者中，当开始使用西诺巴坦时，需要量身定制的滴定和密切随访以达到最佳疗效和耐受性。苯妥英,苯巴比妥,钠通道阻滞剂是高剂量服用的，或者当患者接受两种或多种钠通道阻滞剂时，在锡萘酯滴定期间，应主动降低剂量。仅当患者在滴定期的任何阶段报告中度/重度AE时，才应减少其他伴随的ASM。
结论：西诺巴特是一种有效的ASM，具有剂量依赖性作用。为了最大限度地提高疗效，同时保持最佳的耐受性，需要共同用药管理。本文中包含的建议为接受西诺本治疗的DRE和高载药量患者的联合用药的主动和反应性管理提供了实用指导。
结论：癫痫患者即使在使用几种不同的抗癫痫药物（ASM）治疗后也可能继续发作。Cenobamate是一种ASM，可以减少这些患者的癫痫发作。在这项研究中,西班牙的六位癫痫专家讨论了在耐药性癫痫中使用西诺本酸盐的最佳方法。它们提供了关于何时以及如何调整其他ASM的剂量以减少副作用并优化西伯坦的使用的实用指导。
