Which medications in the drug class Anticonvulsants are used in the treatment of Lennox-Gastaut Syndrome?

Updated: Nov 09, 2018
  • Author: Koshi A Cherian, MD; Chief Editor: Amy Kao, MD  more...
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Answer

Anticonvulsants

These agents prevent seizure recurrence and terminate clinical and electrical seizure activity.

Valproate (Depakote, Depakene, Depacon, Stavzor)

Valproate has been considered the first-line treatment option for children with LGS for the past 2 decades. It is reported to be more effective in patients with cryptogenic LGS than in those with symptomatic LGS.

Lamotrigine (Lamictal, Lamictal ODT, Lamictal XR)

Lamotrigine is valuable for patients with LGS despite risk of idiosyncratic dermatologic reactions. Consider it for use as soon as the diagnosis of LGS is made. Proper attention to concomitant medications, a low starting dose, and very slow titration can minimize the risk of dermatologic reactions. The initial dose, maintenance dose, titration intervals, and titration increments depend on concomitant medications.

Topiramate (Topamax)

Topiramate has been found to be safe and effective as adjunctive therapy (target dose 6 mg/kg/d) for patients with LGS.

Felbamate (Felbatol)

Felbamate has been found to be safe and effective in patients with LGS. However the significant risk of idiosyncratic reactions associated with its use make it a third-line or fourth-line drug for LGS.

Zonisamide (Zonegran)

Zonisamide is effective as long-term adjunctive therapy in children with LGS.

Vigabatrin (Sabril)

Vigabatrin was approved by US Food and Drug Administration (FDA) in 2009 as monotherapy for patients with infantile spasms aged 1 month to 2 years and as adjunctive therapy for adults with refractory complex partial seizures.

Levetiracetam (Keppra, Keppra XR)

Levetiracetam is approved by FDA for partial seizures, but may have efficacy against a range of seizure types in LGS.

Rufinamide (Banzel)

An antiepileptic agent that is structurally unrelated to other antiepileptics, rufinamide modulates sodium channel activity, particularly prolongation of the channel's inactive state. It significantly slows sodium channel recovery and limits sustained repetitive firing of sodium-dependent action potentials. It is indicated for adjunctive therapy in adults and children aged 1 year or older with seizures associated with LGS.

Cannabidiol (Epidiolex)

Purified formulation of cannabidiol indicated for treatment of seizures associated with Lennox-Gastaut syndrome (LGS) or Dravet syndrome (DS) in patients aged 2 years or older. Cannabidiol is a structurally novel anticonvulsant and the exact mechanism by which it produces anticonvulsant effects is unknown. It does not appear to exert its anticonvulsant effects through CB1 receptors, nor through voltage-gated sodium channels.


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