Rufinamide Adjunctive Therapy Reduced Atypical Absence Seizures on EEG: Case Report and Review of the Literature
*William S Baek Department Of Case Reports, United States
*Corresponding Author: William S Baek
Department Of Case Reports, United States Email:William_S_Baek@hotmail.com
Published on: 2016-08-08
Objective:To demonstrate the efficacy and safety of rufinamide as adjunctive therapy for atypical absence epilepsy Methods:Case ReportResults:A 9 year-old boy presented with episodes of pausing while playing, walking or talking.He was diagnosed with partial seizures at 3 years based on an outside EEG with focal right temporal epileptiform discharges and started on oxcarbazepine, which caused sedation. He was then diagnosed with atypical absence seizures and switched to ethosuximide with partial response. Adjunctive levetiracetam was ineffective and lamotrigine caused a diffuse rash. Valproic acid caused temper tantrums. Topiramate affected his cognition.On ethosuximide 250mg twice daily monotherapy he continued to have staring spells.Birth history was normal without any history of developmental delay. He was academically advanced. Review of systems, familyand social history were all negative.His exam was normal.His initial EEG on ethosuximide showed numerous 3-4 Hz generalized irregular spike-polyspike complexes mostly activated by photic stimulation.Rufinamide 400mg twice daily was added to ethosuximide, which decreased seizure duration on EEG by 67% as well as seizure frequency Conclusions:This was a case of atypical absence seizures (AAS) where rufinamide was used as a last resort. Rufinamide may be a promising new antiepileptic drug for AAS and possibly for myoclonic absence seizures.
Rufinamide (RUF) is an FDA-approved triazole derivative for adjunctive therapy in Lennox-Gastaut syndrome (LGS) in ages 4 years and above. Atypical absence seizures (AAS) are generalized seizures associated with slow spike-wave complexes . We present a case of AAS where adjunctive off-label RUF resulted in significant improvement in seizure frequency and duration as demonstrated on EEG.