What are the comparative effects of ethosuximide, sodium valproate, or lamotrigine for children and adolescents with absence seizures?

For children and adolescents with absence seizures, there was little or no evidence of a difference in outcomes between ethosuximide and valproate. However, lamotrigine was less effective than other treatments; fewer patients were seizure free with lamotrigine than with ethosuximide, and fewer patients had a normalized EEG with lamotrigine than with valproate.Comparison of ethosuximide versus valproate revealed no evidence of a difference between groups in the proportion of children and adolescents who were seizure free, or who had 50% or greater reduction in seizure frequency (moderate‐ and low‐certainty evidence, respectively, coming from individual studies). The effect on the proportion of people with an 80% or greater reduction in seizure frequency was uncertain.High‐certainty evidence shows that fewer children and adolescents were seizure free at 12 months (on average, 212 vs 455 per 1000) with lamotrigine than with ethosuximide.Moderate‐certainty evidence shows no clear difference between groups in the proportion of children and adolescents who were seizure free between lamotrigine and valproate, although one larger RCT (292 participants) favored valproate over lamotrigine. More people had a normalized EEG at 12 months with valproate (on average, 652 vs 273 per 1000 people).Comparative adverse events of each drug were not reported, but ethosuximide was commonly associated with nausea, vomiting, and behavioral/psychiatric changes; valproate with fatigue, nausea, vomiting, increased appetite with weight gain, behavioral/psychiatric changes, and thrombocytopenia; and lamotrigine with fatigue and behavioral/psychiatric changes.Fil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin