Rufinamide: a novel broad-spectrum antiepileptic drug

Abstract

The last 20 years have witnessed a tremendous explosion in the number of antiepileptic drugs (AEDs) as well as the introduction of AEDS developed for specific epilepsy syndromes. The study of the efficacy and side effect profile of AEDs for unique epilepsy syndromes has allowed neurologists to utilize evidence-based medicine when treating patients. In late 2008, the Food and Drug Administration approved rufinamide for adjunctive use in the treatment of seizures associated with Lennox-Gastaut syndrome. This unique chemical compound is also the first new AED to reach the market in the United States having a pediatric indication prior to approval for adults. Rufinamide appears to have a broad spectrum of efficacy, is well tolerated, and may be rapidly initiated--properties that will likely extend its use outside of Lennox-Gastaut syndrome.

FIGURE 1

Chemical structure of rufinamide.

FIGURE 3

Long-term, open-label studies of AED efficacy for Lennox–Gastaut syndrome. Abbreviations: FLB, felbamate; TPM, topiramate; RFM, rufinamide. References: 1, #13; 2, #14; 3, #9. Lamotrigine: no long-term data reported.

FIGURE 2

Short-term, double-blind studies on Lennox–Gastaut syndrome. Abbreviations: FLB, felbamate; TPM, topiramate; LTG, lamotrigine; RFM, rufinamide; CLB, clobazam. References: 1, #10; 2, #11; 3, #12; 4, #8; 5, #15. Felbamate: approved for all ages. Lamotrigine and topiramate: approved for ages 2 years and older in Lennox–Gastaut syndrome. Clobazam: high dose is 1 mg/kg/day, max 40 mg/day, given BID; low dose is 0.25 mg/kg/day, max 10 mg/day. There was a significant 14% decrease over 4 weeks.