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Objectives To report efficacy of adjuvant cenobamate in adults with Lennox-Gastaut syndrome (LGS) following cannabidiol.Methodology A retrospective record review was conducted of patients with LGS and ongoing seizures commenced on adjuvant cenobamate after cannabidiol, with changes in seizure frequency and concomitant anti-seizure medications (ASMs) reviewed.Results Fifteen patients (7 male) started on cenobamate of whom fourteen were still on cannabidiol as they fulfilled NICE criteria for continuing prescribing. Of these, 8 had a Vagus Nerve Stimulator (VNS) in situ while an additional 5 were VNS non-responsive. Three had previous surgery (two corpus callosotomy; one left occipital tumour resection). Four had previously tried a ketogenic diet. Eleven had severe intellectual disability. All 15 were on ≥3 ASMs.Cenobamate dose range was 50-400 mg (median 200mg). Three were still titrating. In eight seizure improvement was >50% (including 2 >75%). Two stopped due to side effects and lack of efficacy. Concomitant ASM were simplified in 11 whereby 2 were able to withdraw at least one ASM and 9 were able to reduce doses of more than 2 ASMs.Conclusion Adjuvant cenobamate in adult LGS patients following cannabidiol offers further seizure control and reduces ASM burden as demonstrated in this drug resistant cohort.pyae.aung2@nhs.net