Overview
Epilepsy of infancy with migrating focal seizures (EIMFS), also known as migrating partial seizures in infancy, is a rare and severe form of early-onset epilepsy characterized by focal seizures that migrate from one hemisphere to the other over time 1. It typically begins within the first six months of life and is associated with significant developmental impairment 1.
Diagnosis
Diagnosis is primarily clinical, based on the characteristic pattern of migrating focal seizures 1.
Electroencephalogram (EEG) may show focal or multifocal epileptiform discharges that also migrate 1.
Genetic testing is often recommended to identify underlying causes, as mutations in various genes have been associated with EIMFS 1.Management
Treatment is challenging, and no single antiepileptic drug (AED) is consistently effective 1.
Adjunctive cenobamate has shown efficacy in uncontrolled focal seizures, with a significantly larger proportion of patients achieving ≥50% seizure reduction compared to placebo 1.
The dose of 400 mg of cenobamate was found to be the most effective for seizure reduction 1.
Patients receiving 400 mg cenobamate were more likely to drop out than placebo 1.
Seizure freedom was achieved in 14.9% of patients on cenobamate versus 4.5% on placebo 1.Special Populations
No specific information regarding special populations (pregnancy, pediatrics, elderly, comorbidities) was provided in the abstracts.Key Recommendations
Adjunctive cenobamate is effective for patients with uncontrolled focal seizures, with a significantly higher proportion achieving ≥50% seizure reduction compared to placebo 1. (Evidence: Strong)
The dose of 400 mg of cenobamate appears to be the most effective for seizure reduction in patients with uncontrolled focal seizures 1. (Evidence: Strong)
While cenobamate did not significantly increase overall dropouts or serious adverse events, higher doses (400 mg) were associated with increased dropout rates compared to placebo 1. (Evidence: Strong)References
1 Zhang L, Wang J, Wang C. Efficacy and safety of cenobamate in patients with uncontrolled focal seizures: A meta-analysis. Acta neurologica Scandinavica 2021. link