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. 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.
Yes, you can treat absence seizures with antiepileptics, specifically:
- Valproate (PO), which is indicated for the treatment of simple and complex absence seizures 1
- Ethosuximide (PO), which suppresses the paroxysmal three cycle per second spike and wave activity associated with absence seizures 2
From the Research
Yes, antiepileptics are the primary treatment for absence seizures, with ethosuximide being the preferred initial treatment for children with uncomplicated absence seizures. The most recent and highest quality study, published in 2021 3, compared the efficacy and tolerability of ethosuximide, valproic acid, and lamotrigine in children with newly diagnosed childhood absence epilepsy. The study found that ethosuximide and valproic acid were more effective than lamotrigine, with similar freedom-from-failure rates, and that ethosuximide had fewer adverse attentional effects compared to valproic acid. Key points to consider when treating absence seizures include:
- Ethosuximide is often preferred for children with uncomplicated absence seizures at doses of 20-40 mg/kg/day divided into two doses.
- Valproic acid is effective for multiple seizure types at 10-60 mg/kg/day divided into 2-3 doses, but requires monitoring of liver function and carries teratogenic risks.
- Lamotrigine is started at low doses (0.5 mg/kg/day) and gradually increased to avoid skin reactions, with maintenance doses of 5-15 mg/kg/day.
- Treatment typically continues until the patient has been seizure-free for 2 years, after which gradual withdrawal may be considered.
- Regular follow-up is essential to monitor efficacy, side effects, and medication levels when applicable. It's also important to note that if absence and generalized tonic-clonic seizures coexist, valproate should be preferred, as ethosuximide is probably inefficacious on tonic-clonic seizures 3.