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Absence Epilepsy: Older vs Newer AEDs

  • EPILEPSY (E WATERHOUSE, SECTION EDITOR)
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Opinion statement

Over the last one to two decades, several new antiepileptic drugs (AEDs) have become available. These medications have different mechanisms of action, metabolism, efficacy, and side effect profiles. Hence, it has become possible to customize medications for a particular patient. It has also become possible to use various combinations of treatments for refractory epilepsies. As medication options have increased, our goal has shifted to not only to maximize seizure control but also to minimize side effects. However, the older AEDs are still widely used. So the question arises—are newer medications better than older AEDs for the treatment of absence epilepsy? Based on a large multicenter class I study, older AEDs—ethosuximide and valproic acid—are more efficacious than newer AEDs. Due to reduced side effects, ethosuximide remains the first line treatment for childhood absence epilepsy.

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References and Recommended Reading

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  1. Penry JK, Dreifuss FE. Automatisms associated with the absence of petit mal epilepsy. Arch Neurol. 1969;21(2):142–9.

    Article  CAS  PubMed  Google Scholar 

  2. Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B, et al. Two-year remission and subsequent relapse in children with newly diagnosed epilepsy. Epilepsia. 2001;42(12):1553–62.

    Article  CAS  PubMed  Google Scholar 

  3. Fois A, Malandrini F, Mostardini R. Clinical experiences of petit mal. Brain Dev. 1987;9(1):54–9.

    Article  CAS  PubMed  Google Scholar 

  4. Loiseau P, Pestre M, Dartigues JF, Commenges D, Barberger-Gateau C, Cohadon S. Long-term prognosis in two forms of childhood epilepsy: typical absence seizures and epilepsy with rolandic (centrotemporal) EEG foci. Ann Neurol. 1983;13(6):642–8.

    Article  CAS  PubMed  Google Scholar 

  5. Sato S, Dreifuss FE, Penry JK, Kirby DD, Palesch Y. Long-term follow-up of absence seizures. Neurology. 1983;33(12):1590–5.

    Article  CAS  PubMed  Google Scholar 

  6. Sillanpaa M, Jalava M, Kaleva O, Shinnar S. Long-term prognosis of seizures with onset in childhood. N Engl J Med. 1998;338(24):1715–22.

    Article  CAS  PubMed  Google Scholar 

  7. Trinka E, Baumgartner S, Unterberger I, Unterrainer J, Luef G, Haberlandt E, et al. Long-term prognosis for childhood and juvenile absence epilepsy. J Neurol. 2004;251(10):1235–41.

    Article  PubMed  Google Scholar 

  8. Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months. Epilepsia. 2013;54(1):141–55. This article reports longer-term results from a large multi-center, randomized controlled study in children with CAE.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med. 2010;362(9):790–9. This article reports initial results from a large multi-center, randomized controlled study in children with CAE.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Henkin Y, Sadeh M, Kivity S, Shabtai E, Kishon-Rabin L, Gadoth N. Cognitive function in idiopathic generalized epilepsy of childhood. Dev Med Child Neurol. 2005;47(2):126–32.

    Article  PubMed  Google Scholar 

  11. Levav M, Mirsky AF, Herault J, Xiong L, Amir N, Andermann E. Familial association of neuropsychological traits in patients with generalized and partial seizure disorders. J Clin Exp Neuropsychol. 2002;24(3):311–26.

    Article  PubMed  Google Scholar 

  12. Pavone P, Bianchini R, Trifiletti RR, Incorpora G, Pavone A, Parano E. Neuropsychological assessment in children with absence epilepsy. Neurology. 2001;56(8):1047–51.

    Article  CAS  PubMed  Google Scholar 

  13. Vega C, Guo J, Killory B, Danielson N, Vestal M, Berman R, et al. Symptoms of anxiety and depression in childhood absence epilepsy. Epilepsia. 2011;52(8):e70–4.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Wirrell EC, Camfield CS, Camfield PR, Dooley JM, Gordon KE, Smith B. Long-term psychosocial outcome in typical absence epilepsy. Sometimes a wolf in sheeps’ clothing. Arch Pediatr Adolesc Med. 1997;151(2):152–8.

    Article  CAS  PubMed  Google Scholar 

  15. Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B. How well can epilepsy syndromes be identified at diagnosis? A reassessment 2 years after initial diagnosis. Epilepsia. 2000;41(10):1269–75.

    Article  CAS  PubMed  Google Scholar 

  16. Jallon P, Loiseau P, Loiseau J. Newly diagnosed unprovoked epileptic seizures: presentation at diagnosis in CAROLE study. Coordination Active du Reseau Observatoire Longitudinal de l’ Epilepsie. Epilepsia. 2001;42(4):464–75.

    Article  CAS  PubMed  Google Scholar 

  17. Panayiotopoulos CP. Typical absence seizures and their treatment. Arch Dis Child. 1999;81(4):351–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia. 1989;30(4):389‒99.

    Google Scholar 

  19. Fisher RS, van Emde BW, Blume W, Elger C, Genton P, Lee P, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4):470–2.

    Article  PubMed  Google Scholar 

  20. Mullen SA, Suls A, De Jonghe P, Berkovic SF, Scheffer IE. Absence epilepsies with widely variable onset are a key feature of familial GLUT1 deficiency. Neurology. 2010;75(5):432–40.

    Article  CAS  PubMed  Google Scholar 

  21. Bouma PA, Westendorp RG, van Dijk JG, Peters AC, Brouwer OF. The outcome of absence epilepsy: a meta-analysis. Neurology. 1996;47(3):802–8.

    Article  CAS  PubMed  Google Scholar 

  22. Bartolomei F, Roger J, Bureau M, Genton P, Dravet C, Viallat D, et al. Prognostic factors for childhood and juvenile absence epilepsies. Eur Neurol. 1997;37(3):169–75.

    Article  CAS  PubMed  Google Scholar 

  23. Chaix Y, Daquin G, Monteiro F, Villeneuve N, Laguitton V, Genton P. Absence epilepsy with onset before age three years: a heterogeneous and often severe condition. Epilepsia. 2003;44(7):944–9.

    Article  PubMed  Google Scholar 

  24. Grosso S, Galimberti D, Vezzosi P, Farnetani M, Di Bartolo RM, Bazzotti S, et al. Childhood absence epilepsy: evolution and prognostic factors. Epilepsia. 2005;46(11):1796–801.

    Article  PubMed  Google Scholar 

  25. Sillanpaa M, Jalava M, Shinnar S. Epilepsy syndromes in patients with childhood-onset seizures in Finland. Pediatr Neurol. 1999;21(2):533–7.

    Article  CAS  PubMed  Google Scholar 

  26. Sinclair DB, Unwala H. Absence epilepsy in childhood: electroencephalography (EEG) does not predict outcome. J Child Neurol. 2007;22(7):799–802.

    Article  PubMed  Google Scholar 

  27. Wirrell E, Camfield C, Camfield P, Dooley J. Prognostic significance of failure of the initial antiepileptic drug in children with absence epilepsy. Epilepsia. 2001;42(6):760–3.

    Article  CAS  PubMed  Google Scholar 

  28. Wirrell EC, Camfield CS, Camfield PR, Gordon KE, Dooley JM. Long-term prognosis of typical childhood absence epilepsy: remission or progression to juvenile myoclonic epilepsy [see comments]. Neurology. 1996;47(4):912–8.

    Article  CAS  PubMed  Google Scholar 

  29. Wirrell EC, Camfield PR, Camfield CS, Dooley JM, Gordon KE. Accidental injury is a serious risk in children with typical absence epilepsy [see comments]. Arch Neurol. 1996;53(9):929–32.

    Article  CAS  PubMed  Google Scholar 

  30. Yoshinaga H, Ohtsuka Y, Tamai K, Tamura I, Ito M, Ohmori I, et al. EEG in childhood absence epilepsy. Seizure. 2004;13(5):296–302.

    Article  PubMed  Google Scholar 

  31. Caplan R, Siddarth P, Stahl L, Lanphier E, Vona P, Gurbani S, et al. Childhood absence epilepsy: behavioral, cognitive, and linguistic comorbidities. Epilepsia. 2008;49(11):1838–46.

    Article  PubMed  Google Scholar 

  32. Masur D, Shinnar S, Cnaan A, Shinnar RC, Clark P, Wang J, et al. Pretreatment cognitive deficits and treatment effects on attention in childhood absence epilepsy. Neurology. 2013;81(18):1572–80.

    Article  CAS  PubMed  Google Scholar 

  33. Shinnar S, Berg AT, Moshe SL, Kang H, O'Dell C, Alemany M, et al. Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol. 1994;35(5):534–45.

    Article  CAS  PubMed  Google Scholar 

  34. Loiseau P, Duche B, Pedespan JM. Absence epilepsies. Epilepsia. 1995;36(12):1182–6.

    Article  CAS  PubMed  Google Scholar 

  35. Dreifuss FEND. Classification of epilepsies in childhood. In: Pellock JMDW, Bourgeois BF, editors. Pediatric epilepsy: diagnosis and therapy. 2nd ed. New York: Demos Medical Publishing; 2001. p. 74–5.

    Google Scholar 

  36. Wolf P, Inoue Y. Therapeutic response of absence seizures in patients of an epilepsy clinic for adolescents and adults. J Neurol. 1984;231(4):225–9.

    Article  CAS  PubMed  Google Scholar 

  37. Tovia E, Goldberg-Stern H, Shahar E, Kramer U. Outcome of children with juvenile absence epilepsy. J Child Neurol. 2006;21(9):766–8.

    Article  PubMed  Google Scholar 

  38. Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde BW, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005‒2009. Epilepsia. 2010;51(4):676–85.

    Article  PubMed  Google Scholar 

  39. Senbil N, Soyer O, Turanly G, Gurer YK. Fixation-off sensitivity and generalized epileptic EEG induced by eyes closed. Pediatr Neurol. 2006;35(5):363–6.

    Article  PubMed  Google Scholar 

  40. Striano S, Capovilla G, Sofia V, Romeo A, Rubboli G, Striano P, et al. Eyelid myoclonia with absences (Jeavons syndrome): a well-defined idiopathic generalized epilepsy syndrome or a spectrum of photosensitive conditions? Epilepsia. 2009;50 Suppl 5:15–9.

    Article  PubMed  Google Scholar 

  41. Panayiotopoulos CP. Typical absence seizures and related epileptic syndromes: assessment of current state and directions for future research. Epilepsia. 2008;49(12):2131–9.

    Article  PubMed  Google Scholar 

  42. Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C, et al. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2006;47(7):1094–120.

    Article  PubMed  Google Scholar 

  43. Fattore C, Boniver C, Capovilla G, Cerminara C, Citterio A, Coppola G, et al. A multicenter, randomized, placebo-controlled trial of levetiracetam in children and adolescents with newly diagnosed absence epilepsy. Epilepsia. 2011;52(4):802–9. This article reports results from a recent Class III study evaluating the efficacy of levetiracetam in patients with absence epilepsy.

    Article  CAS  PubMed  Google Scholar 

  44. Genton P. When antiepileptic drugs aggravate epilepsy. Brain Dev. 2000;22(2):75–80.

    Article  CAS  PubMed  Google Scholar 

  45. Guerrini R, Belmonte A, Genton P. Antiepileptic drug-induced worsening of seizures in children. Epilepsia. 1998;39 Suppl 3:S2–S10.

    Article  CAS  PubMed  Google Scholar 

  46. Somerville ER. Some treatments cause seizure aggravation in idiopathic epilepsies (especially absence epilepsy). Epilepsia. 2009;50 Suppl 8:31–6.

    Article  CAS  PubMed  Google Scholar 

  47. Trudeau V, Myers S, LaMoreaux L, Anhut H, Garofalo E, Ebersole J. Gabapentin in naive childhood absence epilepsy: results from two double-blind, placebo-controlled, multicenter studies. J Child Neurol. 1996;11(6):470–5.

    Article  CAS  PubMed  Google Scholar 

  48. Arya R, Greiner HM, Lewis A, Mangano FT, Gonsalves C, Holland KD, et al. Vagus nerve stimulation for medically refractory absence epilepsy. Seizure. 2013;22(4):267–70. This article reports results from a small retrospective study, evaluating seizure outcomes in patients with absence epilepsy being treated with VNS.

    Article  PubMed  Google Scholar 

  49. Groomes LB, Pyzik PL, Turner Z, Dorward JL, Goode VH, Kossoff EH. Do patients with absence epilepsy respond to ketogenic diets? J Child Neurol. 2011;26(2):160–5.

    Article  PubMed  Google Scholar 

  50. Coppola G, Auricchio G, Federico R, Carotenuto M, Pascotto A. Lamotrigine versus valproic acid as first-line monotherapy in newly diagnosed typical absence seizures: an open-label, randomized, parallel-group study. Epilepsia. 2004;45(9):1049–53.

    Article  CAS  PubMed  Google Scholar 

  51. Coppola G, Licciardi F, Sciscio N, Russo F, Carotenuto M, Pascotto A. Lamotrigine as first-line drug in childhood absence epilepsy: a clinical and neurophysiological study. Brain Dev. 2004;26(1):26–9.

    Article  PubMed  Google Scholar 

  52. Frank LM, Enlow T, Holmes GL, Manasco P, Concannon S, Chen C, et al. Lamictal (lamotrigine) monotherapy for typical absence seizures in children. Epilepsia. 1999;40(7):973–9.

    Article  CAS  PubMed  Google Scholar 

  53. Verrotti A, Cerminara C, Domizio S, Mohn A, Franzoni E, Coppola G, et al. Levetiracetam in absence epilepsy. Dev Med Child Neurol. 2008;50(11):850–3.

    Article  PubMed  Google Scholar 

  54. Pina-Garza JE, Schwarzman L, Wiegand F, Hulihan J. A pilot study of topiramate in childhood absence epilepsy. Acta Neurol Scand. 2011;123(1):54–9.

    Article  CAS  PubMed  Google Scholar 

  55. Wheless JW, Clarke DF, Carpenter D. Treatment of pediatric epilepsy: expert opinion. J Child Neurol. 2005;20 Suppl 1:S1–S56. quiz S9‒60.

    PubMed  Google Scholar 

  56. Wheless JW, Clarke DF, Arzimanoglou A, Carpenter D. Treatment of pediatric epilepsy: European expert opinion, 2007. Epileptic Disord. 2007;9(4):353–412.

    PubMed  Google Scholar 

  57. Appleton RE, Panayiotopoulos CP, Acomb BA, Beirne M. Eyelid myoclonia with typical absences: an epilepsy syndrome. J Neurol Neurosurg Psychiatry. 1993;56(12):1312–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Striano P, Sofia V, Capovilla G, Rubboli G, Di Bonaventura C, Coppola A, et al. A pilot trial of levetiracetam in eyelid myoclonia with absences (Jeavons syndrome). Epilepsia. 2008;49(3):425–30.

    Article  CAS  PubMed  Google Scholar 

  59. Sato S, White BG, Penry JK, Dreifuss FE, Sackellares JC, Kupferberg HJ. Valproic acid versus ethosuximide in the treatment of absence seizures. Neurology. 1982;32(2):157–63.

    Article  CAS  PubMed  Google Scholar 

  60. Callaghan N, O'Hare J, O'Driscoll D, O'Neill B, Daly M. Comparative study of ethosuximide and sodium valproate in the treatment of typical absence seizures (petit mal). Dev Med Child Neurol. 1982;24(6):830–6.

    CAS  PubMed  Google Scholar 

  61. Martinovic Z. Comparison of ethosuximide with sodium valproate as monotherapies of absence seizures. Advances in Epileptology: XIVth Epilepsy International Symposium, New York: Raven Press; 1983.

  62. Buoni S, Grosso S, Fois A. Lamotrigine in typical absence epilepsy. Brain Dev. 1999;21(5):303–6.

    Article  CAS  PubMed  Google Scholar 

  63. Holmes GL, Frank LM, Sheth RD, Philbrook B, Wooten JD, Vuong A, et al. Lamotrigine monotherapy for newly diagnosed typical absence seizures in children. Epilepsy Res. 2008;82(2–3):124–32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Jeffrey R. Tenney has received grant support from Citizens United for Research in Epilepsy (CURE). Sejal Jain declares that she has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Jeffrey R. Tenney MD, PhD & Sejal V. Jain MD

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  1. Jeffrey R. Tenney MD, PhD
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  2. Sejal V. Jain MD
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Correspondence to Sejal V. Jain MD.

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This article is part of the Topical Collection on Epilepsy

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Tenney, J.R., Jain, S.V. Absence Epilepsy: Older vs Newer AEDs. Curr Treat Options Neurol 16, 290 (2014). https://doi.org/10.1007/s11940-014-0290-9

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