Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents

Ethosuximide and valproate may have higher efficacy than lamotrigine as initial monotherapy in children and adolescents with absence seizures.

Summary

A Cochrane review included 8 studies with a total of 684 children. Seven studies recruited less than 50 participants. There are no placebo-controlled trials for ethosuximide or valproate. One large (n=446) randomised, parallel double-blind controlled trial comparing ethosuximide, lamotrigine and sodium valproate in children with newly diagnosed childhood absence epilepsy found that at 12 months, the freedom-from-failure rates for ethosuximide and valproic acid (VPA) were similar and were higher than the rate for lamotrigine (45% for ethosuximide vs. 21% for lamotrigine, p<0.001; VPA 44% vs. lamotrigine 21%, p<0.001). The frequency of treatment failures due to lack of seizure control (p<0.001) and intolerable adverse events (p< 0.037) was significantly different among the treatment groups, with the largest proportion of lack of seizure control in the lamotrigine cohort, and the largest proportion of adverse events in the VPA group.

Clinical comments

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Ədəbiyyat

1. Brigo F, Igwe SC. Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents. Cochrane Database Syst Rev 2017;2():CD003032.