Expert Opinion: A New Treatment Algorithm for Lennox-Gastaut Syndrome (LGS) in Adult Patients (P3.5-006)

Objective: To develop a new treatment algorithm for adults with LGS. Background: LGS is characterized by multiple seizure types, abnormal electroencephalogram patterns, and intellectual disability. As patients mature, and because current treatment algorithms are suboptimal for adults with LGS who are newly diagnosed or undergoing transition of care from pediatric to adult services, a new treatment algorithm is needed. Design/Methods: The LGS Transitions of Care Advisory Board (November 2017) met to develop a new treatment algorithm. A pre-meeting survey of antiepileptic drugs (AEDs) most frequently used for LGS treatment in adults formed the basis for categorizing AEDs into Tiers 1–3. Results: Frequent reassessment of adults with LGS was a cornerstone of the proposed treatment algorithm. Tier 1 included FDA-approved AEDs for LGS (clobazam, lamotrigine, rufinamide, topiramate) and valproate. Tier 2 included AEDs commonly used to treat LGS (levetiracetam, perampanel, zonisamide) and cannabidiol (FDA-approved; final placement will require additional clinical experience). Tier 3 included potentially valuable AEDs that lack systematic trial data to support their efficacy (lacosamide, cenobamate, brivaracetam) or have unfavorable toxicity (felbamate). AEDs to be avoided included those less frequently used and which may exacerbate certain seizure types (carbamazepine, eslicarbazepine, gabapentin, phenytoin, pregabalin, oxcarbazepine, vigabatrin). Therapies complementary to AEDs were also assessed and included non-pharmacologic interventions, community services, and psychosocial treatments. Conclusions: Effective and appropriate medications are recommended for treatment of LGS in adults in Tiers 1 and 2 of the treatment algorithm. Tier 3 AEDs lack efficacy data or have unfavorable toxicity. AEDs to be avoided were also identified. Funding: The advisory board was convened and funded by Eisai Inc. All authors were participants of the advisory board and responsible for the decision to develop and submit this abstract. Medical writing support, under the direction of the authors, was funded by Eisai Inc., in accordance with GPP3 guidelines. Disclosure: Dr. Kothare has nothing to disclose. Dr. Aboumatar has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Eisai, Sun Orion. Dr. Burdette has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with UCB, Sun Ovion, Neuropace, Eisai. Dr. Burdette has received research support from Neuropace, Eisai, Eugenix. Dr. Kuzniecky has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Eisai. Dr. Montouris has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Eisai, Lundbeck, SK Life, UCB Pharma, Accorda Therapeutics. Dr. Rosenfeld has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with UCB Pharma, Sunovion Pharmaceuticals, SK Life Science and Eisai. Dr. Rosenfeld has received research support from Greenwich Biosciences, UCB Pharma, SK Life, Neurelis, Takeda Pharmaceutical Company and Ovid Therapeutics, Inc. Dr. Chung has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Ucb, Sunovion, Lundbeck, Eisai. Dr. Chung has received research support from Ucb, SK Life Sciences.