From the FDA Drug Label
The benefit of improved therapeutic effect with higher doses should be weighed against the possibility of a greater incidence of adverse reactions. The probability of thrombocytopenia appears to increase significantly at total valproate concentrations of ≥ 110 μg/mL (females) or ≥ 135 μg/mL (males) Ethosuximide suppresses the paroxysmal three cycle per second spike and wave activity associated with lapses of consciousness which is common in absence (petit mal) seizures.
The complications of absence seizure include thrombocytopenia and other adverse reactions. To diagnose absence seizures in children, it is essential to monitor their behavior and look for signs of lapses of consciousness. The diagnostic approach may involve electroencephalogram (EEG) to detect the paroxysmal three cycle per second spike and wave activity associated with absence seizures 1 2. Valproic acid and ethosuximide are medications used to treat absence seizures in children. However, the dosage and administration of these medications should be carefully managed to minimize the risk of adverse reactions. It is crucial to weigh the benefits of improved therapeutic effect against the possibility of a greater incidence of adverse reactions when using these medications 1.
From the Research
Absence seizures in children can lead to significant complications, including academic difficulties and social challenges, and thus require prompt diagnosis and treatment to minimize morbidity, mortality, and improve quality of life. The diagnostic approach for absence seizures in children should begin with a thorough clinical history, focusing on brief episodes of staring, unresponsiveness, and automatisms lasting 5-30 seconds.
Key Diagnostic Tools
- EEG is the gold standard diagnostic tool, typically showing characteristic 3 Hz spike-and-wave discharges during seizures.
- Hyperventilation for 3-5 minutes during EEG recording often triggers absence seizures, increasing diagnostic yield.
- Video-EEG monitoring may be necessary in unclear cases.
Treatment Options
First-line treatment includes ethosuximide, valproic acid, or lamotrigine.
- Ethosuximide is preferred for uncomplicated absence seizures due to its efficacy and favorable side effect profile, as supported by a study published in 3, which found that ethosuximide and valproic acid had higher freedom-from-failure rates compared to lamotrigine.
- Regular follow-up is essential to monitor treatment response, adjust medication dosages, and assess for side effects.
- Parents and teachers should be educated about seizure recognition and management, as these subtle seizures can be mistaken for daydreaming or inattention, potentially leading to delayed diagnosis and treatment.
Considerations
- A study published in 4 highlights the importance of considering glucose transporter type 1 deficiency in patients with pharmaco-resistant absence seizures, especially if absences started before the age of four years and if neurological signs are present.
- Another study published in 5 suggests that ethosuximide, valproic acid, and lamotrigine are equally effective in the long-term treatment of newly diagnosed childhood absence epilepsy patients, but the onset of efficacy was faster for ethosuximide compared to valproic acid or lamotrigine.
- It is also important to note that valproic acid can occasionally provoke absence seizure aggravation in patients with absence epilepsy, as reported in 6.
Overall, the management of absence seizures in children requires a comprehensive approach, including accurate diagnosis, effective treatment, and ongoing monitoring to minimize complications and improve quality of life, as emphasized by the most recent and highest quality study 3.