In spite of the introduction of numerous new antiseizure drugs (ASD) over the last decades, the percentage of drug-resistant epilepsies has remained almost stable. To achieve seizure freedom in such patients with any modified ASD regimen is an exception. Cenobamate (CNB) is a new ASD that showed unusually high efficacy in the pivotal placebo controlled, randomized trials. In both studies (C013 and C017), the rate of seizure-free patients was sometimes more than 20% and thus in a range never reached over the last decades in comparable trials with other new ASDs. This suggests that CNB which is already approved in the USA might actually offer a new and encouraging perspective for epilepsy treatment concerning efficacy. In this review the pharmacological profile, the currently known mode of action, and the results of the clinical trials are summarized.