When the past challenges the present: are older antiepileptic drugs still the best choice in childhood absence epilepsy?

Abstract

Although valproic acid (valproate) and ethosuximide have been used as first-line drugs for the treatment of absence seizures for more than 40 years, no adequately powered double-blind trial has compared their efficacy and tolerability in this indication until now. 1 Posner EB Mohamed K Marson AG A systematic review of treatment of typical absence seizures in children and adolescents with ethosuximide, sodium valproate or lamotrigine. Seizure. 2005; 14: 117-122 Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar Glauser and colleagues 2 Glauser TA Cnaan A Shinnar S et al. Ethosuximide, valproic acid and lamotrigine in childhood absence epilepsy. N Engl J Med. 2010; 362: 790-799 Crossref PubMed Scopus (423) Google Scholar have recently undertaken a multicentre, randomised, double-blind trial in 453 children with newly diagnosed childhood absence epilepsy. 2 Glauser TA Cnaan A Shinnar S et al. Ethosuximide, valproic acid and lamotrigine in childhood absence epilepsy. N Engl J Med. 2010; 362: 790-799 Crossref PubMed Scopus (423) Google Scholar Lamotrigine, the only second-generation drug approved for the treatment of absence seizures, was also included in the comparison. At the final assessment after 16–20 weeks of treatment (children eligible for a final dose increase at week 16 were followed up for 4 additional weeks), valproate and ethosuximide were similarly effective, but valproate caused greater attentional dysfunction as determined by the Conners' continuous performance test (CCPT) than did the other drugs. Because of this association and because lamotrigine had a lower success rate (29% free from treatment failure) than ethosuximide (53%) and valproate (58%), the authors concluded that “ethosuximide is the optimal initial empirical monotherapy for childhood absence epilepsy”.