USE OF CLOBAZAM AND RUFINAMIDE AS ADJUNCTIVE AGENTS FOR REFRACTORY SEIZURES IN LENNOX-GASTAUT SYNDROME

Purpose: Lennox-Gastaut syndrome (LGS) is a severe childhood epileptic syndrome characterized by multiple types of intractable seizures, mental retardation, and an interictal slow spike and wave pattern with a slow background on electroencephalogram (EEG). Currently, there are only six FDA-approved drugs for LGS in the US. The purpose of this case study is to determine the efficacy of Clobazam and Rufinamide as adjunctive pharmacologic agents for intractable seizures in patients with LGS, as seen in a 40 year old female recently diagnosed with LGS after being refractory to conventional therapies. Methods: Medical records from a 40 year old patient diagnosed with intractable complex partial seizures dating back to 2000 were studied to follow the progression of treatment and the eventual diagnosis and successful treatment of LGS. Results: The patient, with a long history of daily intractable seizures since infancy, was on four-drug regimen (carbamazepine, valproic acid, zonisamide, and topiramate) and a vagus nerve stimulation (VNS) therapy when she was diagnosed with LGS. Despite her current treatment, she still had numerous atonic seizure attacks daily. After adding two adjunctive medications on her regimen, clobazam and rufinamide, the patient's seizure attacks gradually decreased in frequency and intensity. Currently, patient is seizure-free on a dual pharmacologic therapy of clobazam and rufinamide. Conclusions: The results of this case study suggest that dual pharmacologic therapy of clobazam and rufinamide is effective against refractory seizures in patients with LGS particularly in this patient's case. However, seizures in LGS remain to be a challenge, and further studies are recommended to achieve optimal long-term control of the symptoms of this condition.