What is the treatment for absence seizures, also known as petit mal seizures?

From the Guidelines

The primary treatment for absence seizures, also known as petit mal seizures, is anti-seizure medication, with ethosuximide (Zarontin) being the first-line treatment for typical absence seizures. When considering treatment options, it's essential to understand the classification of seizures, as outlined by the International League Against Epilepsy (ILAE) in 2017 1. According to this classification, seizures are categorized as focal onset, generalized onset, or unknown onset, with generalized seizures further subdivided into tonic-clonic, other motor, or nonmotor (absence) 1. The treatment approach for absence seizures involves the use of anti-seizure medications, with the goal of reducing the frequency and severity of seizures while minimizing side effects. Some key points to consider when treating absence seizures include:

• The usual starting dose of ethosuximide is 250 mg twice daily for adults and older children, which can be gradually increased to 500-1500 mg daily as needed.
• Valproic acid (Depakote) and lamotrigine (Lamictal) are effective alternatives, especially when absence seizures occur alongside other seizure types.
• Treatment typically continues for at least two seizure-free years before considering medication withdrawal under medical supervision.
• Patients should avoid potential seizure triggers like hyperventilation, sleep deprivation, and flickering lights.
• Regular follow-up appointments are essential to monitor medication effectiveness and side effects. It's also important to note that these medications work by stabilizing electrical activity in the brain, specifically by affecting calcium channels (ethosuximide), sodium channels, or GABA neurotransmitters (valproic acid) 1. Most children with absence seizures respond well to medication, with many outgrowing the condition by adolescence, though some may require lifelong treatment.

From the FDA Drug Label

Valproic acid is indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types which include absence seizures. Zarontin is indicated for the control of absence (petit mal) epilepsy. The treatment for absence seizures, also known as petit mal seizures, includes:

• Valproic acid (PO): can be used as sole or adjunctive therapy 2
• Ethosuximide (PO): is indicated for the control of absence (petit mal) epilepsy 3

From the Research

Treatment Options for Absence Seizures

The treatment for absence seizures, also known as petit mal seizures, typically involves the use of antiepileptic drugs. The following are some of the commonly used treatment options:

• Ethosuximide: This is often considered the first-line treatment for absence seizures in children and adolescents, as it has been shown to be effective in controlling seizures with minimal side effects 4, 5, 6.
• Valproic acid (valproate): This medication is also effective in controlling absence seizures and is often used in combination with ethosuximide or as an alternative for patients who cannot tolerate ethosuximide 4, 5, 6, 7.
• Lamotrigine: This medication is another option for treating absence seizures, although it may not be as effective as ethosuximide or valproate in some cases 4, 5, 6, 7.
• Combination therapy: In some cases, a combination of two or more antiepileptic drugs may be necessary to achieve optimal seizure control 7, 8.
• Other treatment options: For patients with drug-resistant absence seizures, other medications such as levetiracetam, topiramate, and zonisamide may be considered 8.

Considerations for Treatment

When selecting a treatment for absence seizures, several factors should be considered, including:

• Efficacy: The ability of the medication to control seizures effectively.
• Tolerability: The potential for side effects and the patient's ability to tolerate the medication.
• Syndrome-specific considerations: The presence of other seizure types or syndromes, such as generalized tonic-clonic seizures, may influence the choice of treatment 4, 5, 6, 7.
• Patient-specific factors: The patient's age, medical history, and other health conditions may also impact the choice of treatment.