Abstracts

Rationale: Lennox Gastaut syndrome (LGS) is a severe form of childhood onset epilepsy that accounts for 1-4% of all childhood epilepsies. Seizures associated with LGS are often treatment resistant and children end up on multiple anticonvulsants. Rufinamide is an orally active triazole derivative antiepileptic drug (AED) that is structurally unrelated to other currently available AEDs. Its mode of action may relate to the modulation of sodium channel activity. Rufinamide has been approved as adjunctive treatment of seizures associated with Lennox-Gastaut syndrome in children 4 years and older and adults. Recent clinical trials suggest that the drug has efficacy for partial seizures. We conducted a review of the safety and efficacy of Rufinamide in the management of intractable epilepsy (LGS and Non-LGS) in children treated in our department. Methods: Retrospective review of electronic case records of all children treated with rufinamide from 2007 -2010 in the department of neurology, Birmingham Children s Hospital, U.K supplemented by telephonic questionnaire to parents. Results: A total of 34 children were identified (24 males and 10 females). All children identified had intractable epilepsy .Seventeen (50%) had a diagnosis of LGS. 30 (84%) experienced multiple seizure types. 11 (32%) had >30 seizures /day while 13(38% ) experienced <10 seizures/day. All of them had previously been trialled on 4- 17 anti epileptic medications with poor seizure control. Nine had been tried on ketogenic diet, 3 on VNS and 4 on both VNS and ketogenic diet. Majority of the children (27/34) were > 5 years old at start of Rufinamide therapy. In the LGS group 7(41.2%) had achieved > 50% reduction in seizure frequency including 3(18%) who had complete seizure freedom for 2weeks- 4 months. In 1 child the benefit was sustained for only 4 months while in 2 it was sustained for over a year. 7(41.2%) experienced no change to their seizure frequency while in 3(17.6%) there was a worsening of seizures. In the non-LGS group 3(17.6%) experienced a significant reduction in seizures while 11(64.7%) had no benefit and 3(17.6%) had worsening of seizure frequency. 11 (32%) children experienced side-effects on rufinamide mainly in the form of behavioural changes (6), vomiting (2) and others (constipation, loose stools and unusual sensations). Thirteen children continued on Rufinamide after 1- 2.5 years of use while 1 child had to be weaned off after stabilisation. The drug was withdrawn in 12 because of lack of benefit, in 2 owing to significant side effects and in 6 because of worsening of seizures. Conclusions: In a group of children with severe intractable epilepsy, Rufinamide, in our experience is both effective and safe to use. It is effective both in the in Lennox Gastaut syndrome and other intractable epilepsy syndromes. It was not possible to determine from this retrospective study if Rufinamide is particularly effective against any specific seizure type.