Rufinamide

INTRODUCTION

Indications

Adjunctive treatment of seizures associated with Lennox-Gastaut syndrome in patients older than 4 yr.

Action

Although antiepileptic mechanism is unknown, rufinamide modulates the activity of sodium channels, prolonging the inactive state of the channel. Therapeutic Effects: Decreased incidence and severity of seizures associated with Lennox-Gastaut syndrome.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache, somnolence, ↑ suicidal thoughts/behavior. EENT: diplopia. CV: QT prolongation. GI: nausea, changes in appetite. GU: urinary frequency. Derm: rash. Hemat: anemia. Neuro: ataxia, coordination abnormalities, gait disturbances. Misc: MULTI-ORGAN HYPERSENSITIVITY REACTIONS, hypersensitivity reactions (↑ children).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions involving multiple organs and systems. Common signs include fever, skin rash, other skin reactions (itching, welts, dermatitis), hepatitis (anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, unusual bleeding or bruising), and pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea). Notify physician immediately if these reactions occur.

• Document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, and bruising. Notify physician immediately if these signs occur.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor any behavioral changes or evidence of suicidal thoughts and behaviors. Notify physician or other mental health care professional immediately of these behaviors.

• Assess gait and motor function and document any signs of incoordination, ataxia, or gait disturbances. Report these signs to the physician.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), especially if drowsiness, dizziness, or motor problems affect gait and balance. Implement fall prevention strategies, especially if balance is impaired (See Appendix E).

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Advise patients on prolonged antiseizure therapy not to discontinue medication without consulting their physician. Abrupt withdrawal may cause increased seizures.

• Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong concentration and fast ...