Safety and Efficacy of Cenobamate in Pregnancy: A Case Report

Abstract

Seizures remain the most frequent major neurologic complication during pregnancy, affecting 0.3% to 0.8% of all gestations. In clinical practice, the risk of seizures during pregnancy is weighed against the risks of antiseizure drug (ASD) exposure (e.g. teratogenicity, congenital malformations, developmental, and intrauterine growth). With the advent of novel ASDs, further research into the specific risks of these novel medications during pregnancy is warranted. Cenobamate, a novel ASD approved by the Food and Drug Administration (FDA) for focal onset epilepsy in adults is highly efficacious, however, all trials of this novel ASD to date excluded pregnant and lactating subjects. For this reason, we present the case of a young female patient with medically refractory epilepsy who elected to continue cenobamate throughout two of her pregnancies and lactation. Our patient had a significant reduction in the frequency of her seizures. There were no complications during either pregnancy, delivery, and postpartum period. While a single case experience does not establish the safety and efficacy of cenobamate during pregnancy/lactation, patients of childbearing age who are currently considering or already taking cenobamate may benefit from knowledge regarding our patient’s experience.