Aggravation of atonic seizures by rufinamide: A case report

BackgroundRufinamide is a novel antiepileptic drug used as adjunctive therapy in patients with Lennox–Gastaut syndrome and provides seizure control especially in tonic and atonic seizures. Rufinamide is expected to be effective in intractable epilepsy when atonic and tonic seizures exist. However, rufinamide induced seizure aggravation has been reported in a few patients, which was not associated with a specific type of seizure.CaseA 12-year-old boy with intractable epilepsy had tonic and atonic seizures despite treatment with valproic acid (3000 mg/day), levetiracetam (3000 mg/day) and clobazam (40 mg/day). Rufinamide was administered as adjuvant therapy. After 2 weeks on rufinamide, he experienced atonic seizure worsening, and the frequency of epileptic discharges increased. The deterioration in seizure frequency and epileptiform discharges resolved when rufinamide was discontinued.ConclusionRufinamide may aggravate atonic seizures in patients with intractable epilepsy.