Proposed anti-seizure medication combinations with rufinamide in the treatment of Lennox-Gastaut syndrome: Narrative review and expert opinion

Raman Sankar, Michael Chez, J. Eric Pina-Garza, Tracy Dixon-Salazar, J. Robert Flamini, Ann Hyslop, Patricia McGoldrick, John J. Millichap, Trevor Resnick, Jong M. Rho, Steven Wolf

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

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.

Original languageEnglish
Pages (from-to)42-57
Number of pages16
JournalSeizure
Volume110
DOIs
StatePublished - Aug 2023
Externally publishedYes

Keywords

  • Anti-seizure medications
  • Epilepsy
  • Lennox-Gastaut syndrome
  • Rational polytherapy
  • Rufinamide

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