Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents

• Published in: Cochrane database of systematic reviews 2019-02, Vol.2 (2), p.CD003032
• Main Authors: Brigo, Francesco, Igwe, Stanley C, Lattanzi, Simona
• Format: Article
• Language: English
• Subjects: Adolescent; Anticonvulsants - adverse effects; Anticonvulsants - therapeutic use; Antiepileptic drugs; Child; Child health; Epilepsy, Absence - drug therapy; Ethosuximide - adverse effects; Ethosuximide - therapeutic use; Humans; Lamotrigine - adverse effects; Lamotrigine - therapeutic use; Neurology; Randomized Controlled Trials as Topic; Valproic Acid - adverse effects; Valproic Acid - therapeutic use
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD003032.pub4

This is an updated version of the Cochrane Review previously published in 2017.Absence seizures (AS) are brief epileptic seizures which present in childhood and adolescence. Depending on clinical features and electroencephalogram (EEG) findings they are divided into typical, atypical absences, and absences with special features. Typical absences are characterised by sudden loss of awareness and an EEG typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently used to treat absence seizures. This review aims to determine the best choice of antiepileptic drug for children and adolescents with AS. To review the evidence for the effects of ethosuximide, valproate and lamotrigine as treatments for children and adolescents with absence seizures (AS), when compared with placebo or each other. For the latest update we searched the Cochrane Register of Studies (CRS Web, 29 May 2018), which includes the Cochrane Epilepsy Group's Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to 29 May 2018), ClinicalTrials.gov (29 May 2018) and the WHO International Clinical Trials Registry Platform (ICTRP, 29 May 2018). Previously we searched Embase (1988 to March 2005) and SCOPUS (1823 to 31 March 2014), but this is no longer necessary because randomised controlled trials (RCTs) and quasi-RCTs in Embase and SCOPUS are now included in CENTRAL. No language restrictions were imposed. In addition, we contacted Sanofi Winthrop, Glaxo Wellcome (now GlaxoSmithKline) and Parke Davis (now Pfizer), manufacturers of sodium valproate, lamotrigine and ethosuximide respectively. Randomised parallel group monotherapy or add-on trials which include a comparison of any of the following in children or adolescents with AS: ethosuximide, sodium valproate, lamotrigine, or placebo. Outcome measures were: (1) proportion of individuals seizure free at one, three, six, 12 and 18 months post randomisation; (2) people with a 50% or greater reduction in seizure frequency; (3) normalisation of EEG and/or negative hyperventilation test; and (4) adverse effects. Data were independently extracted by two review authors. Results are presented as risk ratios (RR) with 95% confidence intervals (95% CIs). We used GRADE quality assessment criteria to evaluate the certainty of evidence derived from all included studies. On the basis of our selection criteria, we included no new studies in