Treatment of Lennox-Gastaut Syndrome (LGS).
Lennox-Gastaut Syndrome (LGS) is a severe form of epilepsy that usually starts in early to mid childhood and is characterized by multiple seizure types, abnormal electroencephalogram with slow spike-and-wave discharges and cognitive problems. Numerous approaches are currently used to treat LGS, including use of conventional antiepileptic drugs (most commonly sodium valproate, lamotrigine and topiramate), other drug interventions (corticosteroids and intravenous immunoglobulin) and nonpharmacologic treatments (ketogenic diet, corpus callosotomy and vagus nerve stimulation). Rufinamide is the most recent antiepileptic drug to have shown efficacy in the treatment of LGS. Despite the variety of therapeutic options, there have been only five double-blind, placebo-controlled clinical trials of antiepileptic drugs in LGS and none of these were head-to-head comparison trials. The evidence supporting the use of available treatments for LGS is, therefore, not robust. Here, we review the evidence supporting the use of specific therapies in LGS and provide recommendations on how to set appropriate treatment goals, select treatments and minimize polypharmacy. A suggested treatment algorithm is presented and discussed. Sodium valproate is recommended for first-line therapy; if seizures persist, alternative interventions should be trialed on an individually tailored basis.
Ferrie
Colin D
CD
Department of Paediatric Neurology, Clarendon Wing, Leeds General Infirmary, Leeds LS2 9NS, UK.
Patel
Amit
A
D000927:Anticonvulsants / Q000145:classification / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000150:complications / Q000188:drug therapy; D003337:Corpus Callosum / Q000601:surgery; D004035:Diet Therapy / Q000379:methods; D004311:Double-Blind Method; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D055536:Vagus Nerve Stimulation / Q000379:methods
D000927:Anticonvulsants