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.

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.