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Childhood absence epilepsy is the most common form of pediatric epilepsy, accounting for 10-17% of all cases. Usually beginning between four and eight years of age, it is characterized by daily, frequent (dozens to hundreds) brief staring spells. Ethosuximide, lamotrigine and valproic acid are the three drugs most commonly used for treatment, although studies comparing relative efficacy are lacking. A double-blind, randomized study aimed to determine whether any of these three drugs was optimum as initial empirical monotherapy.
The study included 453 children ranging from 2.5-13 years of age (mean: 7 years, 5 months). They had newly diagnosed absence epilepsy, according to standard criteria, and had not received any antiepileptic medication. The children were randomized to receive one of the three study medications. Doses were increased every one to two weeks until there were no seizures or the maximally tolerated daily dose (established prior to the study) was reached (i.e., ethosuximide 2000 mg, valproic acid 3000 mg, lamotrigine 600 mg). The primary outcome was freedom from treatment failure (treatment failure was defined as persistence of absence seizures, or occurrence of tonic-clonic seizures or dose-limiting adverse effects). Attentional dysfunction was the...