Proposed Anti-Seizure Medication Combinations With Rufinamide in the Treatment of Lennox-Gastaut Syndrome: Narrative Review and Expert Opinion

Authors

Raman Sankar, Departments of Neurology and Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA; UCLA Mattel Children's Hospital, Los Angeles, CA, USA. Electronic address: RSankar@ucla.edu.
Michael Chez, Sutter Health, Roseville, CA, USA; California Northstate University School of Medicine, Elk Grove, CA, USA.
J Eric Pina-Garza, The Children's Hospital at TriStar Centennial, Nashville, TN, USA.
Tracy Dixon-Salazar, Lennox-Gastaut Syndrome Foundation, San Diego, CA, USA.
J Robert Flamini, PANDA Neurology, Atlanta, GA, USA.
Ann Hyslop, Stanford University School of Medicine, Palo Alto, CA, USA.
Patricia McGoldrick, Boston Children's Health Physicians, Valhalla, NY, USA; Maria Fareri Children's Hospital, Valhalla, NY, USA; New York Medical College, Valhalla, NY, USA.
John J. Millichap, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Trevor Resnick, Nicklaus Children's Hospital, Miami, FL, USA.
Jong M. Rho, Departments of Neurosciences, Pediatrics & Pharmacology, University of California San Diego and Rady Children's Hospital, San Diego, CA, USA.
Steven Wolf, Boston Children's Health Physicians, Valhalla, NY, USA; Maria Fareri Children's Hospital, Valhalla, NY, USA; New York Medical College, Valhalla, NY, USA.

Author Type(s)

Faculty

Journal Title

Seizure

First Page

42

Last Page

57

Document Type

Article

Publication Date

8-1-2023

Department

Pediatrics

Abstract

Lennox-Gastaut syndrome (LGS) is a severe, chronic, complex form of early childhood-onset epilepsy characterized by multiple seizure types, generalized slow (≤2.5 Hz) spike-and-wave activity and other electroencephalography abnormalities, and cognitive impairment. A key treatment goal is early seizure control, and several anti-seizure medications (ASMs) are available. Due to the low success rate in achieving seizure control with monotherapy and an absence of efficacy data supporting any particular combination of ASMs for treating LGS, a rational approach to selection of appropriate polytherapy should be applied to maximize benefit to patients. Such "rational polytherapy" involves consideration of factors including safety (including boxed warnings), potential drug-drug interactions, and complementary mechanisms of action. Based on the authors' clinical experience, rufinamide offers a well-considered first adjunctive therapy for LGS, particularly in combination with clobazam and other newer agents for LGS, and may be particularly useful for reducing the frequency of tonic-atonic seizures associated with LGS.

Recommended Citation

Sankar, R., Chez, M., Pina-Garza, J. E., Dixon-Salazar, T., Flamini, J. R., Hyslop, A., McGoldrick, P., Millichap, J. J., Resnick, T., Rho, J. M., & Wolf, S. (2023). Proposed Anti-Seizure Medication Combinations With Rufinamide in the Treatment of Lennox-Gastaut Syndrome: Narrative Review and Expert Opinion. Seizure, 110, 42-57. https://doi.org/10.1016/j.seizure.2023.05.018