Antiseizure Medication Efficacy in Focal Epilepsy
Summary
Focal epilepsy, characterised by seizures originating within a circumscribed region of the cerebral cortex, affects millions worldwide and often proves refractory to initial pharmacotherapy. The primary goal of antiseizure medications (ASMs) in this context is to suppress aberrant neuronal discharge without imposing intolerable adverse effects. Traditional agents target a range of mechanisms, including modulation of voltage-gated sodium and calcium channels, enhancement of γ‐aminobutyric acid (GABA)-mediated inhibition, and attenuation of excitatory neurotransmission. Despite the broad armamentarium, approximately one third of patients with focal-onset seizures continue to experience breakthrough events or intolerable side effects. This unmet need has driven the development of novel compounds with dual or multifaceted modes of action, refined titration schedules to improve tolerability, and strategies for rational polytherapy that minimise drug-drug interactions. Recent work emphasises the importance of real-world evidence in complementing trial data, guiding dose adjustments of concomitant ASMs, and assessing long-term retention and seizure-freedom rates. Collectively, these efforts aim to achieve sustained seizure control, mitigate comorbidities, and enhance quality of life among individuals with focal epilepsy.
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Antiseizure Medication Efficacy in Focal Epilepsy publication trend
The graph below shows the total number of articles in antiseizure medication efficacy in focal epilepsy across all publications each year (not limited to Nature Index journals).
Technical terms
Focal epilepsy: A form of epilepsy in which seizures originate from a distinct, localised area of the brain.
Antiseizure medication (ASM): A pharmaceutical agent designed to reduce the frequency or severity of epileptic seizures.
Persistent sodium current (INaP): A non-inactivating component of sodium influx that contributes to neuronal hyperexcitability and seizure generation.
GABAergic inhibition: Suppression of neuronal activity via the neurotransmitter GABA acting on GABAA receptors.
Responder rate: The proportion of patients achieving a predefined reduction (commonly ≥50%) in seizure frequency.
Seizure freedom: Complete absence of seizures over a specified observation period, indicating optimal ASM efficacy.
References
- Cenobamate, a New Promising Antiseizure Medication: Experimental and Clinical Aspects. International Journal of Molecular Sciences (2024).
- Cenobamate: real-world data from a retrospective multicenter study. Journal of Neurology (2024).
- Indirect treatment comparison of cenobamate to other ASMs for the treatment of uncontrolled focal seizures. Epilepsy & Behavior (2021).
- Cenobamate in refractory epilepsy: Overview of treatment options and practical considerations. Epilepsia Open (2023).
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