Infantile Epilepsy Effectively Treated With Off-Label Anticonvulsant

Xcopri (cenobamate; SK Life Science, Paramus, NJ), an antiseizure therapy approved for refractory focal seizures in adults, has demonstrated potential efficacy as an adjunctive treatment for epileptic spasms in children with Infantile Epileptic Spasms Syndrome (IESS). The results of the retrospective cohort study from the University of California–Los Angeles (UCLA) were presented at the 2025 American Epilepsy Society (AES) Annual Meeting.

Researchers identified 34 children under 18 years old with a history of IESS and ongoing epileptic spasms who received off-label Xcopri treatment through an automated search of UCLA's electronic medical record database. Data collected included demographics, epilepsy syndrome classification, burden of epileptic spasms, peak dosage and duration of treatment, time from IESS diagnosis to Xcopri initiation, and treatment-related adverse events. The median age at initiation was 6.8 years, and the median time from initial IESS diagnosis to initiation was 5.5 years. The median peak dosage was 137.5 mg/d or 5.6 mg/kg/d.

Key results included:

• 57% of participants (20) showed at least subjective improvement in epileptic spasms burden from the perspective of either the treating neurologist or caregiver.
• 20% (7) achieved complete resolution of epileptic spasms.
• 65% (22) remained on Xcopri at the most recent follow-up.
• Median duration of treatment was 18.8 months for patients who continued Xcopri and 5 months for those who discontinued.
• Reasons for discontinuation included lack of efficacy (8), poor tolerability (3), and increased seizures (2).

The authors emphasized that prospective trials with uniform video-EEG quantification of epileptic spasms burden before and after Xcopri exposure represent an essential next step for validating these findings. 

Source: Moyen S, Peters H, Terango A, et al. Cenobamate as an adjunct therapy in children with infantile epileptic spasms syndrome: the UCLA experience. Presented at: American Epilepsy Society Annual Meeting; December 5–9, 2025; Atlanta, GA.