Absence Epilepsy: Older vs Newer AEDs
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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.
KeywordsEpilepsy Antiepileptic drugs Treatment AED Childhood absence epilepsy Juvenile absence epilepsy Jeavons syndrome
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Conflict of Interest
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.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 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.PubMedCentralPubMedCrossRefGoogle 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.PubMedCentralPubMedCrossRefGoogle 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
- 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
- 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.PubMedCrossRefGoogle 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.PubMedCrossRefGoogle 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.PubMedCrossRefGoogle 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.Google Scholar