Absence seizures: valproate or ethosuximide?

Abstract

A series of 47 children with absence seizures was analysed retrospectively. Fourteen of these children also had other types of seizures, and four had repeated episodes of absence status. The age at onset of absence seizures ranged from 1 1/2 to 13 years (mean, 7.9 years). The mean follow-up was 5.5 years. Ethosuximide (ESM) was used as the drug of first choice in 43 children, and valproate (VPA) was used first in 4 children; 15 of the patients later received VPA alone or in combination with ESM. A 100% reduction in seizure frequency was achieved in 38 children (80.8%). Of these, 23 has received ESM (21 ESM; 2 ESM + nitrazepam) and 15 had received VPA (6 VPA; 9 VPA + ESM). Of the latter group, 11 children had had an unsuccessful trial of ESM. VPA was superior in the treatment of children who had EEG polyspikes or absence status. A seizure reduction of 50% to 75% was achieved in 7 children (14.9%). Two patients (4.3%) had refractory seizures. A transient Stevens-Johnson syndrome occurred in a patient treated with ESM. Other side effects were mild and transient. Both ESM and VPA are needed in the treatment of absence seizures. In refractory cases, the combination of these drugs appears to be beneficial.