Treatment of Lennox-Gastaut Syndrome When Seizure Control Remains Suboptimal

In Lennox-Gastaut syndrome, when seizure control remains inadequate despite current therapy, a structured approach to adjunctive anti-seizure medication (ASM) is required. This protocol provides evidence-based guidance on agent selection and on managing concurrent ASM use.

Treatment approach

The protocol involves selecting an adjunctive ASM from a defined, evidence-reviewed group of agents — and includes a key principle governing how many ASMs should be used at the same time.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1002/epi4.13075

If seizure control remains suboptimal, subsequent adjunctive ASM treatment options include (alphabetically) cannabidiol, clobazam, felbamate, fenfluramine, and topiramate, although evidence for these is more limited.

When considering adding an adjunctive therapy, every attempt should be made to discontinue one of the two previous ASMs once the new ASM has been introduced, since there is no evidence for the effectiveness of more than two ASMs in combination, and the use of multiple ASMs unnecessarily raises the risk of side effects and/or drug–drug interactions.

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