Successful treatment of super-refractory tonic status epilepticus with rufinamide: First clinical report

Thompson, Anita; Cock, Hannah R.

doi:10.1016/j.seizure.2016.04.003

Cited by 11 publications

(10 citation statements)

References 5 publications

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“…Rufinamide allowed discontinuation of other AEDs, including barbiturate and clobazam, at discharge. The patient had no neurologic complications at follow‐up appointments but was not seizure free (approximately one seizure per month) . Because the outcome of this case was positive, it should serve to spur future research into the use of RFM for SE, RSE, or SRSE.…”

Section: Discussionmentioning

confidence: 90%

“…Review of the literature shows only a single case report of a 24‐year‐old man. Rufinamide was used to treat his SRSE (Table ) . On admission, seizure activity was reported to be 1–2 minutes for greater than 95% of the time.…”

Section: Discussionmentioning

confidence: 99%

“…Rufinamide was used to treat his SRSE ( Table 7). 74 On admission, seizure activity was reported to be 1-2 minutes for greater than 95% of the time. Nine AEDs with hypothermia had been used before initiation of RFM.…”

Section: Rufinamide/rfm (Banzel)mentioning

confidence: 99%

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Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

et al. 2019

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Status epilepticus (SE) has a high mortality rate and is one of the most common neurologic emergencies. Fast progression of this neurologic emergency and lack of response to traditional antiepileptic drugs (AEDs) in most cases has challenged clinicians to use new agents. This article evaluates the efficacy and safety of AEDs released to the market after 2000 for SE, refractory status epilepticus (RSE), and super‐refractory status epilepticus (SRSE). The PubMed database was searched for clinical trials published between January 2000 and July 2018 using the search terms status epilepticus, refractory status epilepticus, super refractory status epilepticus, brivaracetam, clobazam, cannabidiol, eslicarbazepine, lacosamide, perampanel, rufinamide, stiripentol, and zonisamide. Trials that evaluated these agents in adults with SE, RSE, and SRSE were included. Brivaracetam use was identified in two retrospective reviews with success rates of 27% and 57%. One unsuccessful case report of cannabidiol use in SE was found. Four clobazam studies were identified in SE and RSE with success rates ranging from 25–100%. No evidence for the use of eslicarbazepine and zonisamide was found. Using the search terms for lacosamide identified 38 articles: 1 systematic review, 5 prospective studies, 15 retrospective reviews, and 17 case reports. Success rates and dosing varied, but studies that included focal or partial types of SE showed higher success rates. Five articles were identified regarding perampanel use in this setting. Three were retrospective reviews with success rates ranging from 17–60%, and two were case reports. Only one case report regarding the use of rufinamide was found; rufinamide titrated up to 4.4 mg/day allowed discontinuation of barbiturate and clobazam. One case report and two case series of stiripentol were found with reported efficacy between 60% and 100% in SRSE. Evidence is currently insufficient to support the use of these agents in this setting.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

et al. 2019

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“…A recently published clinical report [7] also indicated that rufinamide was successful in the treatment of super-refractory tonic-status epilepticus. Rufinamide was granted orphan drug status by the European Medicines Agency (EMA) and the US FDA in 2004 for the treatment of Lennox–Gastaut syndrome (LGS).…”

Section: Newest Orphan Antiepileptic Drugsmentioning

confidence: 99%

“…Drug interactions data are comparable to those for (PER) perampanel. A current report suggests a reference range of 126–168 μmol/l (30–40 mg/l) in LGS, which presumably would be lower for other seizure types [7]. High-performance liquid chromatography (HPLC) [13] and liquid chromatography–mass spectrometry (LC–MS) [14] can be used to determine plasma/serum concentrations.…”

Section: Newest Orphan Antiepileptic Drugsmentioning

confidence: 99%

An Updated Overview on Therapeutic Drug Monitoring of Recent Antiepileptic Drugs

2016

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Given the distinctive characteristics of both epilepsy and antiepileptic drugs (AEDs), therapeutic drug monitoring (TDM) can make a significant contribution to the field of epilepsy. The measurement and interpretation of serum drug concentrations can be of benefit in the treatment of uncontrollable seizures and in cases of clinical toxicity; it can aid in the individualization of therapy and in adjusting for variable or nonlinear pharmacokinetics; and can be useful in special populations such as pregnancy. This review examines the potential for TDM of newer AEDs such as eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, perampanel, pregabalin, rufinamide, retigabine, stiripentol, tiagabine, topiramate, vigabatrin, and zonisamide. We describe the relationships between serum drug concentration, clinical effect, and adverse drug reactions for each AED as well as the different analytical methods used for serum drug quantification. We discuss retrospective studies and prospective data on the serum drug concentration–efficacy of these drugs and present the pharmacokinetic parameters, oral bioavailability, reference concentration range, and active metabolites of newer AEDs. Limited data are available for recent AEDs, and we discuss the connection between drug concentrations in terms of clinical efficacy and nonresponse. Although we do not propose routine TDM, serum drug measurement can play a beneficial role in patient management and treatment individualization. Standardized studies designed to assess, in particular, concentration–efficacy–toxicity relationships for recent AEDs are urgently required.

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How Can an Na⁺ Channel Inhibitor Ameliorate Seizures in Lennox–Gastaut Syndrome?

Lin

Lai

Chou

et al. 2021

Annals of Neurology

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Objective Lennox–Gastaut syndrome (LGS) is an epileptic encephalopathy frequently associated with multiple types of seizures. The classical Na+ channel inhibitors are in general ineffective against the seizures in LGS. Rufinamide is a new Na+ channel inhibitor, but approved for the treatment of LGS. This is not consistent with a choice of antiseizure drugs (ASDs) according to simplistic categorical grouping. Methods The effect of rufinamide on the Na+ channel, cellular discharges, and seizure behaviors was quantitatively characterized in native neurons and mammalian models of epilepsy, and compared with the other Na+ channel inhibitors. Results With a much faster binding rate to the inactivated Na+ channel than phenytoin, rufinamide is distinctively effective if the seizure discharges chiefly involve short bursts interspersed with hyperpolarized interburst intervals, exemplified by spike and wave discharges (SWDs) on electroencephalograms. Consistently, rufinamide, but not phenytoin, suppresses SWD‐associated seizures in pentylenetetrazol or AY‐9944 models, which recapitulate the major electrophysiological and behavioral manifestations in typical and atypical absence seizures, including LGS. Interpretation Na+ channel inhibitors shall have sufficiently fast binding to exert an action during the short bursts and then suppress SWDs, in which cases rufinamide is superior. For the epileptiform discharges where the interburst intervals are not so hyperpolarized, phenytoin could be better because of the higher affinity. Na+ channel inhibitors with different binding kinetics and affinity to the inactivated channels may have different antiseizure scope. A rational choice of ASDs according to in‐depth molecular pharmacology and the attributes of ictal discharges is advisable. ANN NEUROL 2021;89:1099–1113

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Successful treatment of super-refractory tonic status epilepticus with rufinamide: First clinical report

Cited by 11 publications

References 5 publications

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

An Updated Overview on Therapeutic Drug Monitoring of Recent Antiepileptic Drugs

How Can an Na⁺ Channel Inhibitor Ameliorate Seizures in Lennox–Gastaut Syndrome?

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Successful treatment of super-refractory tonic status epilepticus with rufinamide: First clinical report

Cited by 11 publications

References 5 publications

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

An Updated Overview on Therapeutic Drug Monitoring of Recent Antiepileptic Drugs

How Can an Na+ Channel Inhibitor Ameliorate Seizures in Lennox–Gastaut Syndrome?

Contact Info

Product

Resources

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How Can an Na⁺ Channel Inhibitor Ameliorate Seizures in Lennox–Gastaut Syndrome?