Severe memory decline along with unaffected executive functions under 400 mg/day of cenobamate leading to a collapse in school performance

ABSTRACT

Cenobamate (CNB) is one of the newer antiseizure medications for the treatment of focal-onset seizures. The cognitive profile of CNB is not yet known in detail. Here we present the case of an 18-year-old male high school student with epilepsy who received adjunctive CNB. Under 400 mg/d of CNB in combination with lamotrigine, a neuropsychological reassessment revealed a severe deterioration of the formerly normal episodic memory functions, while executive functions remained unaffected. The de novo memory deficit had already led to a collapse in school performance and he unexpectedly failed to obtain the general qualification for university entrance. Given the beneficial effect of CNB on seizure control, a dose reduction of CNB to 200 mg/d and introduction of valproic acid was performed. This led to a full recovery of objective memory performance. To our knowledge this is the very first report of a dose-dependent, selective and severe decline in episodic memory performance under CNB, potentially impeding academic achievement. The findings call for a cognitive monitoring of CNB which also addresses episodic memory in addition to executive functions. Systematic studies on episodic memory upon CNB treatment would help to appreciate the scope of this apparently reversible adverse effect.

KEYWORDS:

• Epilepsy
• antiseizure medication
• antiepileptic drugs
• side effects
• neuropsychology
• cognition
• memory decline

Disclosure statement

JAW reports personal fees from Eisai, outside the submitted work. SMH reports personal fees or travel expenses from Eisai, UCB, Desitin, LivaNova and Precisis AG, outside the submitted work. KOD has no disclosures relevant to this work. RS has received personal fees as speaker or for serving on advisory boards from Angelini, Arvelle, Bial, Desitin, Eisai, Jazz Pharmaceuticals Germany GmbH, Janssen-Cilag GmbH, LivaNova, LivAssured B.V., Novartis, Precisis GmbH, Rapport Therapeutics, UCB Pharma, UNEEG, and Zogenix. These activities were not related to the drafting and the explicit content of this manuscript. CH reports honoria for speeches, webinars, counseling etc. from UCB, Eisai, Angelini, GW, Precisis, Jazz Pharma, honoraria for expert testimonies, as well as license fees from UCB and Eisai. These activities were not related to the drafting and the explicit content of this manuscript.

Data availability statement

Due to the nature of this research, the patient of this study did not agree for their data to be shared publicly, so supporting data is not available.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.