Abstracts

Rationale: Rufinamide (Banzel), a triazole derivative, is an antiepileptic drug (AED) approved by the United States Food and Drug Administration in 2009 for the treatment Lennox-Gastaut syndrome (LGS) in patients aged ≥4 years. Clinical trials have shown that rufinamide is effective in lowering seizure frequency in LGS and refractory partial onset epilepsy. In this retrospective study, we analyzed patients treated with rufinamide as an adjunctive therapy. Our data reveals that although rufinamide has efficacy in reduction of seizures, in some individuals it might be associated with exacerbating seizures. Methods: We completed a retrospective chart review of patients with intractable seizures treated with rufinamide from 2010 to 2012. Data variables included gender, age, epileptic syndrome, etiology, EEG findings, AED dosage, and adverse effects. Seizure frequency prior to and after introducing rufinamide was recorded. Results: We identified 24 patients on rufinamide, 17 males and 7 females. Rufinamide dosage was 200mg BID to 1600mg BID. Fifteen had LGS, 6 had partial onset epilepsy, and 3 had primary generalized epilepsy. Of the total 24 patients, 14 remained on rufinamide and had decreased seizure frequencies. Eight patients discontinued rufinamide due to adverse effects, which included increased seizure frequency (5/8), anorexia (1/8), rash (1/8), and dizziness (1/8). Two patients did not have any improvement and were weaned off. Out of the 5 patients with paradoxical effects, 4 carried the diagnosis of LGS as follows: three were symptomatic and one was cryptogenic. One of the 5 patients had partial onset epilepsy. Patients' ages with a paradoxical effect ranged from 19-45 years old and were all male. All were on polytherapy and treated with other AEDs, including valproic acid (3/5), lamotrigine (3/5), topiramate, (2/5), carbamazepine (1/5), phenobarbital (1/5), levetiracetam (1/5), zonegran (1/5), and pregabalin (1/5). In all of these patients rufinamide was the last AED that was introduced prior to the increase in seizure frequency. All four patients with LGS had frequent generalized spike/polyspike with slow wave discharges and significant background slowing on EEG. All five patients had increased frequency of seizures, respective of their usual seizure types, from baseline. Among our total patient population an increase in seizure frequency was seen in 21% of patients. Conclusions: This retrospective study reports a paradoxical effect on five males prescribed rufinamide as an adjunctive treatment. During the clinical course, patients experienced more seizures with initiation and increase in dose. Although, rufinamide appears to be a safe and effective treatment for many individuals with intractable epilepsy, we found it had a paradoxical effect in approximately one- fifth of our population. Despite the already published studies our data calls for more prospective studies in the future with larger sample size to determine the probability of a paradoxical effect with rufinamide to better educate both health care providers and patients.