What is the treatment for absence seizure?

From the Guidelines

Absence seizures are typically treated with anti-seizure medications, with valproic acid being a commonly recommended option, as per the guidelines for management of epilepsy 1. The treatment approach for absence seizures involves the use of medications that can help control the frequency and severity of seizures.

• The guidelines recommend considering valproic acid as a treatment option, especially in cases where the seizure type is not specified, as it is effective for various types of seizures, including absence seizures 1.
• Other medications like phenobarbital, carbamazepine, and phenytoin may also be considered, but the choice of medication depends on individual patient factors, such as the type of seizure, age, and medical history 1.
• It is essential to note that the treatment of absence seizures should be individualized, and the medication should be chosen based on the specific needs of the patient, as recommended in the guidelines for people with intellectual disability and epilepsy 1.
• The guidelines also emphasize the importance of avoiding high-risk activities and providing information on first aid and seizure management to patients and their families 1.
• Regular follow-up with a neurologist is crucial to monitor the effectiveness of the medication and adjust the treatment plan as needed, ensuring the best possible outcome for the patient in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

Valproic acid is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, and in simple and complex absence seizures. The recommended initial dose is 15 mg/kg/day, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are controlled or side effects preclude further increases. The maximum recommended dosage is 60 mg/kg/day. 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.

Absence Seizure Treatment: Valproate is indicated for the treatment of simple and complex absence seizures. The recommended initial dose is 15 mg/kg/day, increasing at one week intervals by 5 to 10 mg/kg/day until seizures are controlled or side effects preclude further increases. The maximum recommended dosage is 60 mg/kg/day 2.

From the Research

Absence Seizure Treatment Options

• Ethosuximide, sodium valproate, and lamotrigine are commonly used to treat absence seizures in children and adolescents 3, 4, 5, 6, 7
• A study comparing these treatments found that ethosuximide and valproic acid were more effective than lamotrigine in controlling seizures, with ethosuximide having fewer adverse attentional effects 6
• Valproic acid is also effective in controlling generalized tonic-clonic seizures and myoclonic jerks, but may be undesirable for some women due to its side effects 5
• Lamotrigine may worsen myoclonic jerks and has a higher risk of skin rashes 5
• Ethosuximide is considered the optimal initial empirical monotherapy for children and adolescents with absence seizures, but valproate may be preferred if absence and generalized tonic-clonic seizures coexist 3

Treatment Efficacy and Tolerability

• A double-blind, randomized, controlled clinical trial found that ethosuximide and valproic acid had similar freedom-from-failure rates, which were higher than the rate for lamotrigine 6
• The study also found that attentional dysfunction was more common with valproic acid than with ethosuximide 6
• A review of the evidence found that ethosuximide represents the optimal initial empirical monotherapy for children and adolescents with absence seizures, due to its efficacy and tolerability 3
• However, the review also noted that the certainty of the evidence for the outcomes derived from the included studies was low, primarily due to risk of bias and imprecise results because of small sample sizes 3

Clinical Considerations

• A practical guide to treatment of childhood absence epilepsy recommends ethosuximide as the treatment of choice for CAE with absence seizures only, due to its efficacy and lower risk of adverse effects compared to valproic acid and lamotrigine 7
• The guide also emphasizes the importance of careful assessment and treatment of psychosocial comorbidities in patients with CAE 7
• Refractory CAE occurs in fewer than half of patients, and treatment strategies are available, although efficacy data are lacking 7