In 1999, topiramate trials showed that topiramate decreased seizure occurrence by more than 50%.Felbamate is the treatment of last resort in the event that everything else fails, and was found to be superior to placebo in controlling treatment resistant partial seizures and atonic seizures. However, it has been known to cause aplastic anemia and liver toxicity. First-line drugs
valproate (valproic acid, sodium valproate and valproate semisodium)

Second-line drugs
lamotrigineThird-line drugs

rufinamide
topiramateTreatment of last resort

felbamate

Adjuvant drugs
Are the following:
benzodiazepines, specifically clonazepam, nitrazepam, and clobazam
zonisamide
cannabidiol

Surgery
In the past, LGS patients were not eligible for surgery, as the medical community thought it to involve the whole brain as a generalized epilepsy in all cases. Since 2010, this assumption has been challenged. Two studies on LGS patients series who underwent curative surgery in Korea and China, showed very good results, up to seizure freedom for 80% of these patients below 5 years old, and 40% above 5 years old. Like all epilepsy curative surgeries, seizures may recur in the years following surgery, but surgery allows the child to have better brain development during the seizure free period.There are several procedures that have shown efficacy:
vagus nerve stimulation, which involves implantation of battery-operated generator of intermittent electrical stimuli to an electrode wrapped around left vagus nerve. Some studies have been shown it to have greater than 50% reduction in seizures reported in more than half of patients. corpus callosotomy, which has shown to be effective with atonic seizures.
Lennox–Gastaut syndrome (LGS) is a complex, rare, and severe childhood-onset epilepsy. It is characterized by multiple and concurrent seizure types, cognitive dysfunction, and slow spike waves on electroencephalogram (EEG). Typically, it presents in children aged 3–5 years and can persist into adulthood. It has been associated with several gene mutations, perinatal injuries, congenital infections, brain tumors/malformations, and genetic disorders such as tuberous sclerosis and West syndrome. The prognosis for LGS is poor with a 5% mortality in childhood and persistent seizures into adulthood (80%–90%).LGS was named for neurologists William G. Lennox (Boston, USA) and Henri Gastaut (Marseille, France), who independently described the condition. The international LGS Awareness Day is  on November 1. Signs and symptoms
The symptoms vary and progress with age and are characterized by a triad of seizures, cognitive dysfunction, and EEG findings. The triad may not fully emerge until 1–2 years after first seizure episode. Seizures
The peak age of onset of seizures is typically between 3 and 5 years of age. The mainstay symptoms are seizures that are frequent – occurring daily and difficult to treat with antiseizure medications. An estimated 30% of patients with infantile spasms (West syndrome) have been reported to progress with LGS.The seizures are most commonly tonic seizures. They occur most frequently during non-REM sleep (90%). They initially last only a few seconds and are activated by sleep. The presentation can be subtle.