This protocol addresses a distinct clinical scenario: Lennox-Gastaut syndrome (LGS) that has progressed from a prior epilepsy syndrome — such as infantile epileptic spasms syndrome (IESS) — in a patient who has not yet been treated with sodium valproate.
Many patients are diagnosed with LGS after progressing over time from another epilepsy syndrome, or after having received anti-seizure medication (ASM) therapy to manage seizures prior to a formal LGS diagnosis being established. When such a patient is not already receiving sodium valproate, their management follows a specific clinical pathway that accounts for both the evolved nature of the epilepsy and the absence of prior valproate exposure.
Once the initial management step is in place, the approach in this setting involves adjunctive anti-seizure medication (ASM) therapy, drawing from a defined set of options with varying levels of supporting evidence.
An important principle guiding any adjustment to the regimen is the aim to keep concurrent ASM use as streamlined as possible rather than accumulating multiple agents.