Reductions in concomitant antiseizure medication drug load during adjunctive cenobamate therapy: Post-hoc analysis of a subset of patients from a phase 3, multicenter, open-label study.

OBJECTIVE: Many patients with epilepsy require polytherapy, which increases their antiseizure medication (ASM) drug load, a measure that considers the doses of all ASMs a patient is taking. Changes in concomitant ASM drug load after adding cenobamate were evaluated post-hoc in a subset of the open-label, phase 3 study. METHODS: Patients 18-70 years old with uncontrolled focal seizures taking 1-3 ASMs were enrolled. Total concomitant ASM drug load (not including cenobamate) was calculated by dividing the patient's prescribed dose for each ASM by its defined daily dose, per the World Health Organization, then summing the ratios. Changes in concomitant ASM drug load were measured from baseline in 3-month intervals up to 24 months by both total and class-specific ASM drug load. Subgroups of interest included: older adults (65-70 years), prior epilepsy-related surgery vs none, and baseline seizure frequency < 3 vs ≥ 3 seizures/28 days. RESULTS: Data from 240 patients were available (mean age 41.8 years, mean baseline drug load 3.57). Following cenobamate initiation, the mean concomitant ASM drug load was reduced by 29.4 % at Month 12 % and 31.8 % at Month 24. Reductions occurred in all assessed ASM drug classes, with the largest reduction in benzodiazepines (55.2 % at Month 24). Each assessed subgroup exceeded a 30 % reduction in concomitant ASM drug load at Month 24. Over 24 months, maintenance of ≥ 50 % response occurred in 89.3 %, 86.4 %, and 90.6 % of patients with low (-0.25 to <0), moderate (-0.59 to -0.25), or high (-3.3 to -0.59) numerical reductions in concomitant ASM drug load from baseline, respectively, compared with 86.0 % in patients with no change in drug load; maintenance of 100 % response occurred in 80.7 %, 84.3 %, and 70.0 % of patients with low, moderate, or high numerical reductions in concomitant ASM drug load, compared with 82.0 % in patients with no change. CONCLUSIONS: Adding cenobamate led to reduced mean concomitant ASM drug loads during 1 and 2 years of treatment. Reductions occurred regardless of ASM drug class, patient age, or epilepsy disease characteristics and did not impact maintenance of response rates.

Intramuscular lipoma of the supraspinatus causing impingement syndrome.

Impingement syndrome is a common ailment of the shoulder, particularly in individuals who perform repetitive overhead activities, such as athletes and laborers. Patients typically report progressive shoulder pain often exacerbated by flexion and abduction and may demonstrate a classic painful arc of motion. This article describes a case of a 45-year-old man with signs and symptoms consistent with impingement syndrome. Workup revealed a well-circumscribed, homogeneous lesion within the supraspinatus muscle on magnetic resonance imaging. The patient underwent uncomplicated marginal excision of the mass with a final diagnosis of benign lipoma. Lipomas represent one of the most common soft tissue tumors, although there are no reports of an intramuscular supraspinatous lipoma causing impingement syndrome. In our case, there were no findings on history, physical examination, or radiographs that would place neoplasm high on a differential. Magnetic resonance imaging provided the crucial information necessary to narrow the differential diagnosis and formulate a preoperative plan. Marginal resection of the mass was curative in this patient, as he remained pain free and regained excellent motion postoperatively.