zonisamide / Generic mfg. - LARVOL DELTA

Application of acoustic ejection mass spectrometry for plasma protein binding assay using flux dialysis. (PubMed, Drug Metab Dispos) - "Herein, we validated this approach using 10 commercially available compounds with known fu values-imipramine, indomethacin, itraconazole, lapatinib, nicardipine, warfarin, chlorpromazine, rivastigmine, zonisamide, and ritonavir-with a wide fu range covering from very high binding (fu ≤ 0.01) to low binding (fu > 0.10) in human plasma. SIGNIFICANCE STATEMENT: This study bridges the gap between flux dialysis and acoustic ejection mass spectrometry by creating a synergistic analytical framework for plasma protein binding assays, addressing limitations of both methods and enabling high-throughput applications with improved accuracy and efficiency. The combination of flux dialysis and acoustic ejection mass spectrometry will make a positive contribution to the development of high-throughput in vitro absorption, distribution, metabolism and excretion assays in drug discovery."

Journal

Phase II pilot randomized trial of zonisamide for disease modification in prodromal Lewy body disease. (PubMed, NPJ Parkinsons Dis) - "Somnolence, fatigue, decreased appetite, and constipation were frequent adverse events. Although findings are inconclusive due to limited power, this study provides valuable methodological insights for preventive LBD trials."

Clinical • Journal • P2 data • CNS Disorders • Cognitive Disorders • Constipation • Dementia • Fatigue • Gastroenterology • Gastrointestinal Disorder • Lewy Body Disease • Movement Disorders

Antiseizure medication effects on the autonomic nervous system in pediatric patients with epilepsy. (PubMed, Epilepsy Res) - "Zonisamide and topiramate showed reduced sweating and increased temperature. In polytherapy patients, HRV decreased, with reductions in high-frequency (HF) values on valproic acid and low-frequency values on phenobarbital...Two studies reviewing the effect of levetiracetam found minimal short-term ANS effects within the ECG but improved parasympathetic control and restored balance in HRV parameters over time...A better understanding of how ASMs affect ANS is essential for assessing medication efficacy, side effects, and their role as confounders in seizure prediction. These biosignal data can support device-based neuromodulation, seizure detection, and prediction algorithms."

Journal • Review • CNS Disorders • Epilepsy • Novel Coronavirus Disease • Pediatrics

Case Report: Zonisamide-induced DRESS syndrome with progression toward SJS: the first Chinese case and review of the literature on ZNS-associated SCARs. (PubMed, Front Med (Lausanne)) - "Overall, 75% of patients improved following glucocorticoid-based therapies. This study aims to enhance awareness of SCARs associated with ZNS-including DRESS, SJS, and toxic epidermal necrolysis (TEN)-to support early recognition and timely clinical interventions."

Journal • CNS Disorders • Eosinophilia • Epilepsy • Epstein-Barr Virus Infections • Hepatology • Immunology • Liver Failure • Pain • Steven-Johnson Syndrome

Cenobamate and Brivaracetam Use in Pregnancy and Lactation - A Case Report (AES 2025) - "She previously failed multiple ASMs, including clonazepam, gabapentin, oxcarbazepine, levetiracetam, lamotrigine, zonisamide, and phenytoin, due to inadequate seizure control or intolerable side effects. This case describes a normal pregnancy outcome in a young female with intractable localization-related epilepsy on combination cenobamate and brivaracetam. To our knowledge, this is the first reported pregnancy outcome with this specific ASM combination. This offers reassuring, preliminary evidence that cenobamate and brivaracetam may be safely continued in pregnancy when benefits outweigh risks, especially in intractable epilepsy."

Case report • Clinical • Anesthesia • CNS Disorders • Epilepsy

Temporal Lobe Laser Ablation as Treatment for Epilepsy in Koolen deVries Syndrome: A Case Report (AES 2025) - "Seizure frequency included one to two breakthrough seizures monthly despite polytherapy with ASMs including clonazepam, zonisamide, and lacosamide. This case demonstrates that surgical interventions done for patients with more common forms of epilepsy, such as temporal lobe laser ablations, can also be effective treatment options for patients with Koolen de-Vries Syndrome (KdVS)-associated epilepsy as well. Our patient achieved seizure freedom for at least 12 months following surgery with no significant adverse effects. These findings suggest that surgical evaluation should be considered in KdVS patients with medication-resistant epilepsy and correlating EEG and MRI abnormalities."

Case report • Clinical • CNS Disorders • Developmental Disorders • Dystonia • Epilepsy • Mental Retardation • Movement Disorders • Psychiatry • KANSL1

Efficacy and Tolerability of RAP-219, a Potential First-in-Class Negative Allosteric Modulator of γ8 Transmembrane AMPA Receptor Associated Protein: Impact on RNS Long Episodes and Focal Seizures (AES 2025) - "Use of perampanel was exclusionary...The most common ASMs were lamotrigine, cenobamate, levetiracetam, zonisamide, and clobazam... The baseline characteristics of the patients enrolled in this innovative POC study testing the electrographic and clinical effect of RAP-219 in RNS patients with FOS are similar to those reported in contemporary Phase 2 and 3 studies. Efficacy, safety, and tolerability of RAP-219 (to be reported) as evaluated during the 8-week, open-label treatment trial are expected to be highly relevant to patients with drug-resistant FOS."

Clinical • Late-breaking abstract • CNS Disorders • Epilepsy

Multi-Night Analysis on the Effect of Epilepsy Medication on Sleep Spindles in Intracranial EEG (AES 2025) - "Each patient took between 1-4 anti-epilepsy medications, which included Lamotrigine, Topiramate, Cenobamate, Clobazam, Oxcarbazepine, Briviact, Carbamazepine, Lacosamide, and Zonisamide. This preliminary analysis into muti-medication effects on sleep spindles during a multi-night EMU stay with intracranial EEG, suggests that there could be a relationship between anti-epilepsy medication dosages and sleep spindle rates. If confirmed in a larger cohort, the observed increase in sleep spindle rate with higher medication doses might suggest a positive effect of medication on sleep. This could be an indirect consequence of the decrease in epileptiform activity, which might permit the augmentation of sleep spindles even outside the seizure onset zone."

CNS Disorders • Epilepsy

Rare Case Study of Unverricht-Lundborg Disease in Two Siblings: Insight to Genetics and Phenotypic Expression (AES 2025) - "The current regimen includes clonazepam, valproic acid, felbamate, brivaracetam, and cannabidiol. The younger sibling also requires zonisamide... In cases of stimulus-induced myoclonus, progressive GTCs, and ataxia with cognitive decline, clinicians should consider Progressive Myoclonic Epilepsy type 1 (ULD) and confirm with genetic testing. Antiepileptic polytherapy is required. While stimulus-sensitive myoclonic jerks can be resistant, GTCs may respond favorably to treatment."

Case study • Clinical • Ataxia • CNS Disorders • Depression • Epilepsy • Gastrointestinal Disorder • Movement Disorders • Psychiatry

Pilomotor Seizures Provoked by Amygdalar/Hippocampal Stimulation (AES 2025) - "At the time of the stimulation, the patient was taking levetiracetam, oxcarbazepine, and zonisamide. Our case highlights a rare form of autonomic seizures with piloerection and chills as cardinal features, originating from the right amygdala and hippocampus. sEEG confirmed seizure onset in these regions, and cortical stimulation reliably reproduced symptoms. This work reinforces the role of mesial temporal structures, particularly the amygdala and hippocampus, in autonomic seizure semiology."

Cardiovascular • CNS Disorders • Epilepsy

Extending Epilepsy and Pregnancy Registers: A Pilot in The UK Epilepsy and Pregnancy Register to Include Routine Longitudinal Child Follow Up (AES 2025) - "These numbers included rarer ASM exposures such as clobazam, cenobamate, zonisamide, lacosamide and brivaracetam. A dual model of both surveillance and enhanced investigations offers the opportunity to routinely collect screening level child health and neurodevelopmental outcome data across large geographical regions, alongside more enhanced researcher-led data collection for subpopulations. Implementing longitudinal routine child health and neurodevelopmental investigations into already established initiatives such as Epilepsy and Pregnancy Registers will improve available data regarding the safe use of ASMs in women of reproductive age."

Clinical • CNS Disorders • Epilepsy

Clusters of Epileptic Spasms in an Adolescent with Facioscapulohumeral Muscular Dystrophy Type 1 (AES 2025) - "Facial weakness began at age 3, with scapular winging and shoulder weakness noted by age 15, prompting genetic testing.Focal seizures began at age 5 with characteristics of left arm extension and rhythmic shaking and was treated with oxcarbazepine. This case highlights epileptic spasms as an atypical manifestation in FSHD1, emphasizing the role of prolonged EEG in accurate diagnosis and treatment."

CNS Disorders • Epilepsy • Movement Disorders • Muscular Dystrophy • Otorhinolaryngology • DUX4

Real-World Evidence Study of Clobazam in Developmental Epileptic Encephalopathies: Comparing Clinical Outcomes of Clobazam Pill/Suspension vs Clobazam Oral Film (AES 2025) - "Additional ASMs in the oral film versus pill/suspension groups included levetiracetam (18% vs 22%, respectively) and zonisamide (6% vs 8%, respectively).Regarding safety, when comparing pts treated with clobazam oral film versus pill/suspension, no statistically significant differences were observed in the incidence of constipation (8% vs 10%, respectively; odds ratio [OR]=1.23; P=1), fatigue (9% each; OR=1.58; P=0.74), pyrexia (9% vs 8%, respectively; OR=0.572; P=0.71), or somnolence (2% vs 4%, respectively; OR=1; P=1).Additionally, lower prevalence of mood/neurobehavioral conditions (depression, anxiety, ADHD, conduct disorders) was observed in the film group versus pill/suspension group (13% vs 19%,respectively; P=0.015). In this real-world study of pts with epilepsy, similar rates of ASM side effects such as constipation, fatigue, pyrexia, and somnolence, but lower prevalence of mood/neurobehavioral conditions, were observed among pts taking clobazam oral film..."

Clinical • Clinical data • HEOR • Real-world • Real-world evidence • ADHD (Impulsive Aggression) • Alzheimer's Disease • Attention Deficit Hyperactivity Disorder • Autism Spectrum Disorder • Behavior Disorders • Cerebral Palsy • CNS Disorders • Cognitive Disorders • Constipation • Depression • Developmental Disorders • Epilepsy • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Mood Disorders • Psychiatry • Pulmonary Disease • Respiratory Diseases

Epilepsy Course And Treatment Response In Individuals With CACNA1A Haploinsufficiency: A Multicenter And Automated Literature-Based Analysis (AES 2025) - "ASMs with broad mechanism of action (valproate, topiramate, zonisamide) resulted in seizure decrease (20/29 use cases, 69%), whereas ethosuximide only led to seizure decrease in 2/7 (28.6%) cases. Epilepsy in LoF CACNA1A variants presents with marked phenotypic variability and predominantly generalized phenotypes with typical and atypical absence seizures that are not responsive to ethosuximide. Earlier seizure onset and higher degree of intellectual disability may be associated with worse seizure control in this population. The presence of EA, though often delayed, along with developmental delay, can prompt considering genetic testing in individuals with history of generalized epilepsy."

Clinical • Absence Seizure Disorder • Ataxia • CNS Disorders • Developmental Disorders • Epilepsy • Mental Retardation • Movement Disorders • CACNA1A

Common practices of ketogenic diet programs: A survey of neurologists from U.S. pediatric epilepsy centers (AES 2025) - "Citrate prophylaxis is used empirically at KDT onset in 19% (n=3) of centers and selectively in classic ketogenic diet patients in another 12% (n=2), whereas 7 (43%) start citrate based on presence of acidosis, urine findings, or concomitant medications (eg topiramate or zonisamide). Despite the extensive use of the KD and well-documented complications, implementation, surveillance, and treatment of the KD and its side effects were quite variable in this survey of 16 US centers. This offers an opportunity for comparative analysis studies attempting to identify optimal KD surveillance as well as identifying areas of possible future clinical studies."

Clinical • CNS Disorders • Epilepsy • Metabolic Disorders • Nephrology • Pediatrics • Renal Calculi

Pseudohypoparathyroidism Spuriously Masking as Juvenile Myoclonic Epilepsy - An Argument for Early Genetic Testing (AES 2025) - "Despite trial of high doses of Keppra, Depakote, Zonisamide, and Ethosuximide, he continued to have frequent daily absence seizures, impairing his ability to attend school. Though this patient met all clinical and electrographic criteria for a diagnosis of JME, his genetic testing revealed he unexpectedly had pseudohypoparathyroidism, a treatable endocrine disorder. Pseudohypoparathyroidism can present with multiple seizure semiologies and generalized interictal discharges on EEG, similarly to JME, however, it is treated very differently. This case illustrates the value and importance of considering early genetic testing in JME patients, especially if medically intractable."

Absence Seizure Disorder • CNS Disorders • Endocrine Disorders • Epilepsy • Metabolic Disorders

Cenobamate in Generalized Epilepsies: Case Reports in Juvenile Myoclonic Epilepsy and PCDH19-Related Epilepsy (AES 2025) - "We present two cases demonstrating significant clinical response to off-label cenobamate use in generalized epilepsy syndromes. Retrospective case series of two females with drug-resistant generalized epilepsy syndromes treated with off-label cenobamate. Case 1 (JME): A 22-year-old female with JME experienced absence, myoclonic, and generalized tonic-clonic seizures (GTCs) refractory to multiple ASMs, including valproate, lamotrigine, topiramate, and zonisamide...Trials of oxcarbazepine, zonisamide, and lacosamide failed; VNS and cannabidiol (Epidiolex) offered partial benefit... These cases highlight the promising role of cenobamate as an off-label adjunctive treatment in refractory generalized epilepsies. In both patients, cenobamate significantly reduced seizure frequency and allowed withdrawal or dose reduction of prior ASMs with unfavorable side-effect profiles. Given its favorable pharmacodynamic profile and real-world efficacy, further clinical trials are..."

Case report • Clinical • Absence Seizure Disorder • Alopecia • CNS Disorders • Epilepsy • Movement Disorders

Experiences Reported by People with Epilepsy During Antiseizure Medication Shortages in the UK: A Cross-Sectional Survey. (PubMed, Pharmacy (Basel)) - "Shortages were most frequently reported for sodium valproate (60.8%), lamotrigine (65.2%), carbamazepine (92.6%), clobazam (82.6%), topiramate (81.5%), zonisamide (74.0%), levetiracetam (62.8%), lacosamide (71.0%), and brivaracetam (70.5%). (4) ASM shortages are a widespread issue for people with epilepsy in the UK, leading to treatment disruptions and psychological distress. Addressing supply change limitations and identifying effective approaches to preventing the substitution of ASMs brands by clinicians may potentially reduce this problem."

Journal • CNS Disorders • Epilepsy • Mood Disorders • Psychiatry

EPIPOP: Population Pharmacokinetics of Antiepileptic in Pediatrics (clinicaltrials.gov) - P=N/A | N=753 | Completed | Sponsor: Assistance Publique - Hôpitaux de Paris | Recruiting ➔ Completed

Trial completion • CNS Disorders • Epilepsy • Pediatrics

Disproportionality Analysis of Urinary Stone Formation with Carbonic Anhydrase Inhibitors: A VigiBase Analysis. (PubMed, Urol Pract) - "Significant disproportionality signals were observed for topiramate (ROR 4.91; 95% CI 4.27-5.65), zonisamide (ROR 8.00; 95% CI 5.84-10.96), and acetazolamide (ROR 2.56; 95% CI 1.42-4.62). Younger patients and patients with indication of seizure had higher risk of reporting stone-related ADRs. At-risk patients should be counseled on the risk of developing stones when taking CAIs."

Journal • CNS Disorders • Epilepsy • Urolithiasis

Intracellular transport of PSD-95 is impaired by the Cav3.1 mutation causing SCA42. (Neuroscience 2025) - "The improvement in PSD-95 intracellular transport dysfunction by zonisamide may be attributed to the shift in the voltage-dependent properties of mutated calcium channels induced by zonisamide, which improves local calcium currents in neurons. The observation that pharmacological intervention ameliorates transport dynamics suggests that our experimental system is useful platform for evaluating candidate therapeutics targeting intracellular transport mechanisms in spinocerebellar degeneration."

Ataxia • CNS Disorders • Movement Disorders • CAV3

Rare but Critical: Isolated Zonisamide-Induced Hyperammonemic Encephalopathy (KIDNEY WEEK 2025) - "This case highlights the need to consider zonisamide as a potential cause of hyperammonemic encephalopathy, even in the absence of hepatic dysfunction, concurrent antiepileptic use, or supratherapeutic drug levels. Prompt discontinuation of zonisamide and treatment of complications can lead to resolution of symptoms."

Acute Kidney Injury • Atrial Fibrillation • Cardiovascular • CNS Disorders • Cognitive Disorders • Dyslipidemia • Epilepsy • Hepatology • Hypertension • Infectious Disease • Liver Failure • Metabolic Disorders • Nephrology • Ophthalmology • Pneumonia • Renal Calculi • Renal Disease • Respiratory Diseases • Septic Shock

Status epilepticus of carotid web after carotid artery stenting: A case report. (PubMed, J Int Med Res) - "Regarding therapy, intravenous infusion of sodium valproate successfully terminated the status epilepticus secondary to stroke, providing an alternative when clinicians are concerned about the depression of diazepam. Subsequent oral antiseizure medications were required and newer-generation agents (e.g. levetiracetam, lacosamide, zonisamide, and topiramate) were increasingly recommended due to their neutral impact on secondary stroke prevention."

Journal • Atherosclerosis • Cardiovascular • CNS Disorders • Depression • Epilepsy • Ischemic stroke • Psychiatry • Thrombosis

TREATMENT OF REFRACTORY POSTANOXIC MYOCLONIC STATUS EPILEPTICUS WITH CANNABIDIOL (CHEST 2025) - "Despite treatment with levetiracetam, propofol, and fentanyl, the patient developed myoclonic status epilepticus during rewarming phase...Lacosamide, valproic acid, clobazam, and phenobarbital were added without improvement in myoclonus...Perampenel, zonisamide, gabapentin, baclofen, clonidine was added to antiseizure medication regimen and no improvement noticed...On day 50, cannabidiol (Epidiolex) 2.5 mg/kg twice daily was added to her regimen, resulting in significant improvement in myoclonus and paroxysmal sympathetic activity immediately after first dose... Cannabidiol may be a promising treatment for refractory post-anoxic myoclonic status epilepticus. Further research is warranted to establish its efficacy and optimal dosing in this context."

Anesthesia • Asthma • Cardiovascular • Epilepsy • Hypertension • Immunology • Movement Disorders • Respiratory Diseases

Unravelling the role of cerebellar α6GABAA receptors in anti-tremor pharmacotherapies. (PubMed, Biomed Pharmacother) - "Results showed that gabapentin (30 mg/kg, i.p.), topiramate (30 mg/kg, i.p.), propranolol (20 mg/kg, i.p.), diazepam (4 mg/kg, i.p.), zonisamide (20 mg/kg, i.p.), and oxcarbazepine (15 mg/kg, i.p.) significantly attenuated harmaline (20 mg/kg, s.c.)-induced action tremor in ICR mice. Furosemide per se did not alter harmaline tremor. These results suggest that cerebellar α6GABAARs contribute, at least partly, to the anti-tremor effects of topiramate and gabapentin and that α6GABAAR-selective positive modulators are a potential novel therapy for ET patients."

Journal • Addiction (Opioid and Alcohol) • Essential Tremor • Movement Disorders