Evaluation of Treatment in Typical Absence Seizures: The Roles of Long‐term EEG Monitoring and Ethosuximide

Blomquist, H K; Zetterlund, Bo

doi:10.1111/j.1651-2227.1985.tb10994.x

Cited by 21 publications

(13 citation statements)

References 10 publications

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“…Blomquist and Zetterlund [106] studied 11 children with typical absence seizures, both clinically and by repeated 24-hour EEG. Eight (73%) became seizure-free on ethosuximide and had normalised EEG.…”

Section: Ethosuximidementioning

confidence: 99%

Treatment of Typical Absence Seizures and Related Epileptic Syndromes

Panayiotopoulos

2001

Paediatric Drugs

295

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Typical absences are brief (seconds) generalised seizures of sudden onset and termination. They have 2 essential components: clinically, the impairment of consciousness (absence) and, generalised 3 to 4Hz spike/polyspike and slow wave discharges on electroencephalogram (EEG). They differ fundamentally from other seizures and are pharmacologically unique. Their clinical and EEG manifestations are syndrome-related. Impairment of consciousness may be severe, moderate, mild or inconspicuous. This is often associated with motor manifestations, automatisms and autonomic disturbances. Clonic, tonic and atonic components alone or in combination are motor symptoms; myoclonia, mainly of facial muscles, is the most common. The ictal EEG discharge may be consistently brief (2 to 5 seconds) or long (15 to 30 seconds), continuous or fragmented, with single or multiple spikes associated with the slow wave. The intradischarge frequency may be constant or may vary (2.5 to 5Hz). Typical absences are easily precipitated by hyperventilation in about 90% of untreated patients. They are usually spontaneous, but can be triggered by photic, pattern, video games stimuli, and mental or emotional factors. Typical absences usually start in childhood or adolescence. They occur in around 10 to 15% of adults with epilepsies, often combined with other generalised seizures. They may remit with age or be lifelong. Syndromic diagnosis is important for treatment strategies and prognosis. Absences may be severe and the only seizure type, as in childhood absence epilepsy. They may predominate in other syndromes or be mild and nonpredominant in syndromes such as juvenile myoclonic epilepsy where myoclonic jerks and generalised tonic clonic seizures are the main concern. Typical absence status epilepticus occurs in about 30% of patients and is more common in certain syndromes, e.g. idiopathic generalised epilepsy with perioral myoclonia or phantom absences. Typical absence seizures are often easy to diagnose and treat. Valproic acid, ethosuximide and lamotrigine, alone or in combination, are first-line therapy. Valproic acid controls absences in 75% of patients and also GTCS (70%) and myoclonic jerks (75%); however, it may be undesirable for some women. Similarly, lamotrigine may control absences and GTCS in possibly 50 to 60% of patients, but may worsen myoclonic jerks; skin rashes are common. Ethosuximide controls 70% of absences, but it is unsuitable as monotherapy if other generalised seizures coexist. A combination of any of these 3 drugs may be needed for resistant cases. Low dosages of lamotrigine added to valproic acid may have a dramatic beneficial effect. Clonazepam, particularly in absences with myoclonic components, and acetazolamide may be useful adjunctive drugs.

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Section: Ethosuximidementioning

confidence: 99%

Treatment of Typical Absence Seizures and Related Epileptic Syndromes

Panayiotopoulos

2001

Paediatric Drugs

295

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“…ESM produces complete control of absences in 70% of treated patients (4,5), but it is unsuitable as monotherapy when other generalized seizure types coexist. Recently, lamotrigine (LTG) was shown to be effective as both add‐on and monotherapy for typical absence seizures and generalized tonic–clonic seizures in ∼50 to 60% of patients (6–12), although it may worsen myoclonic jerks (13), and skin rashes are a concern (14).…”

mentioning

confidence: 99%

Lamotrigine versus Valproic Acid as First‐line Monotherapy in Newly Diagnosed Typical Absence Seizures: An Open‐label, Randomized, Parallel‐group Study

et al. 2004

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Summary: Purpose:To compare the efficacy of lamotrigine (LTG) and valproic acid (VPA) in newly diagnosed children and adolescents with typical absence seizures.Methods: A randomized, open-label parallel-group design was used. After undergoing an awake video-EEG recording, which included one to two trials of 3 min of hyperventilation and intermittent photic stimulation, eligible patients were randomized to receive LTG or VPA. LTG was initiated at a daily dose of 0.5 mg/kg for 2 weeks in two divided doses, followed by 1.0 mg/kg/day for an additional 2 weeks. Thereafter, doses were increased in 1-mg/kg/day increments every 5 days until seizures were controlled, intolerable adverse effects occurred, or a maximum dose of 12 mg/kg/day had been reached. VPA was equally uptitrated according to clinical response, starting at 10 mg/kg and increasing by 5 mg/kg/24 h every 3 days, if required, to a maximum of 30 mg/kg/day in three divided doses. Patients were seen in the clinic every month for ≤12 months.The primary efficacy end point at each visit was seizure freedom, defined as lack of clinically observed seizures since the previous visit and lack of electroclinical seizures during ambulatory 24-h EEG testing and a video-EEG session with hyperventilation.Results: Thirty-eight children (17 boys, 21 girls), aged from 3 to 13 years (mean, 7.5 years), all newly diagnosed with childhood or juvenile typical absence seizures, were enrolled. After 1 month of treatment, 10 (52.6%) of 19 children taking VPA and one (5.3%) of 19 taking LTG were seizure free (p = 0.004). By the 3-month follow-up, 12 (63.1%) children taking VPA and seven (36.8%) taking LTG were controlled (p = 0.19). After 12 months, 13 children taking VPA (dose range, 20-30 mg/kg/day; mean serum level, 76.8 mg/L; range, 51.4-91 mg/L) and 10 taking LTG (dose range, 2-11 mg/kg/day; mean serum level, 8.1 mg/L; range, 1.1-18 mg/L) were seizure free (p = 0.51). Side effects were mostly mild and transient and were recorded in two (10.6%) children treated with VPA and in six (31.8%) treated with LTG.Conclusions: Both VPA and LTG can be efficacious against absence seizures, although VPA shows a much faster onset of action, at least in part because of its shorter titration schedule.

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“…The drug ethosuximide, for example, has been added to the treatment regimes of children with absence seizures, and IQ tests given before and after the new treatment. In this design, Guey, Charles, Coquery, Roger and Soulayrol (1967) found a deterioration, after up to 6 months of therapy, in full-scale and verbal IQ scores; Roger, Grangeon, Guey and Lob (1968) found a significant drop in full-scale IQ; Browne et al (1975) found a significant improvement on the overall rating of performance on IQand neuropsychological tests; Blomquist and Zetterlund (1985) found improved school performance in four out of 11 children treated. None of these studies involved the key element of random allocation to the treatment or a control condition; and correspondingly the effect of therapy is confounded with the reasons for which it was given.…”

Section: Anticonvulsant Medicationmentioning

confidence: 95%

Developmental Neuropsychiatry

Taylor

1991

Child Psychology Psychiatry

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Evaluation of Treatment in Typical Absence Seizures: The Roles of Long‐term EEG Monitoring and Ethosuximide

Cited by 21 publications

References 10 publications

Treatment of Typical Absence Seizures and Related Epileptic Syndromes

Treatment of Typical Absence Seizures and Related Epileptic Syndromes

Lamotrigine versus Valproic Acid as First‐line Monotherapy in Newly Diagnosed Typical Absence Seizures: An Open‐label, Randomized, Parallel‐group Study

Developmental Neuropsychiatry

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