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Rufinamide for generalized seizures associated with Lennox–Gastaut syndrome

From Cincinnati Children’s Hospital (T.G.), Cincinnati, OH; BHZ Vogtareuth (G. Kluger), Germany; Princeton and Rutgers Neurology (R.S.), Princeton, NJ; Johns Hopkins Medical Center (G. Krauss), Baltimore, MD; and Eisai Global Clinical Development (C.P., S.A.), Ridgefield Park, NJ.

Address correspondence and reprint requests to Dr. Tracy Glauser, Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 2015, C-5, Cincinnati, OH 45229 tracy.glauser{at}cchmc.org

Background: Lennox–Gastaut syndrome is a catastrophic pediatric epilepsy syndrome characterized by multiple types of treatment-resistant seizures and high rates of seizure-related injury. Current available treatments are inadequate, leaving patients with few treatment options and opportunities.

Methods: We conducted a double-blind, randomized, placebo-controlled trial of the antiepileptic drug rufinamide in patients with Lennox–Gastaut syndrome. Eligible patients between 4 and 30 years of age had multiple types of seizures (including tonic–atonic and atypical absence seizures) with a minimum of 90 seizures in the month before baseline and a recent history of a slow spike-and-wave pattern on EEG.

Results: After a 28-day baseline period, 139 eligible patients were randomized; 138 patients received either rufinamide (n = 74) or placebo (n = 64) in addition to their other antiepileptic drugs. The median percentage reduction in total seizure frequency was greater in the rufinamide therapy group than in the placebo group (32.7% vs 11.7%, p = 0.0015). There was a difference (p < 0.0001) in tonic–atonic ("drop attack") seizure frequency with rufinamide (42.5% median percentage reduction) vs placebo (1.4% increase). The rufinamide group had a greater improvement in seizure severity (p = 0.0041) and a higher 50% responder rate compared with placebo for total seizures (p = 0.0045) and tonic–atonic seizures (p = 0.002). The common adverse events (reported by 10% of patients receiving rufinamide) were somnolence (24.3% with rufinamide vs 12.5% with placebo) and vomiting (21.6% vs 6.3%).

Conclusions: Rufinamide was an effective and well-tolerated treatment for seizures associated with Lennox–Gastaut syndrome.

Editorial, page 1946

e-Pub ahead of print on April 9, 2008, at www.neurology.org.

See the appendix for a list of Rufinamide Lennox–Gastaut Study Group members.

Disclosure: Sponsored by Eisai Pharmaceutical and conducted by Novartis Pharmaceutical. T.G. and R.S. have received personal compensation (honorarium) from the current sponsor of the study (Eisai), which did not exceed $10,000 per year during the course of the study. G. Kluger reports no conflicts of interest. G. Krauss received grants from Eisai Pharmaceutical for other research or activities not reported in this article but not in excess of $10,000. C.P. and S.A. are employees of Eisai Pharmaceutical.

Received April 18, 2007. Accepted in final form September 17, 2007.

This article has been cited by other articles:

				J. W. Wheless Managing Severe Epilepsy Syndromes of Early Childhood J Child Neurol, August 1, 2009; 24(8_suppl): 24S - 32S. [Abstract] [PDF]

				W. D. Shields Children get their due: A study of pediatric epilepsy patients before drug approval Neurology, May 20, 2008; 70(21): 1946 - 1947. [Full Text] [PDF]