Cenobamate use in super‐refractory status epilepticus: A report of three cases

Objectives Super‐refractory status epilepticus (SRSE) is a neurological emergency with high morbidity and mortality. Cenobamate, a novel antiseizure medication, may be helpful in managing SRSE, but evidence is limited. Methods This retrospective case series reports the use of cenobamate as add‐on therapy in the management of three cases of SRSE. Results Median age at status epilepticus (SE) onset was 28 years (range 27–75). The etiologies of SRSE included one case of febrile infection‐related epilepsy syndrome (FIRES), one patient with a probable genetic etiology (SCN7A variant of uncertain significance), and one case of unknown etiology. Cenobamate was introduced at a median of 27 days (range 13–103) after SE onset. Resolution of SRSE was observed after a median of 7 days (range 3–30) once cenobamate was started. Median dose of cenobamate at SRSE cessation was 25 mg/day (range 12.5–50 mg/day), and the median maintenance dose at the time of discharge was 200 mg/day (range 100–400 mg/day). Two patients died and one patient achieved functional independence. No severe medication side effects, specifically drug reaction with eosinophilia and systemic symptoms (DRESS), were observed. Discussion Cenobamate may have a role in the management of SRSE. Further studies are needed to define the optimal timing of initiation, titration strategy, and target dose of cenobamate in the context of SE.