Drug of Choice for Absence Seizures: The Definitive Guide

Absence seizures, or petit mal seizures, are a type of seizure during which a person briefly loses awareness or responsiveness. They might seem to be gazing into space and have repetitive movements such as lip-smacking or blinking.

Selecting the appropriate treatment is crucial for controlling and managing the condition. These seizures can impact a person’s quality of life if untreated.

This article will explore the optimal medication choices for absence seizures based on the patient’s age. I will also clarify how these medicines work, their dosages, side effects, and contraindications. 

So, stick here and keep reading!

Drug of Choice for Absence Seizures in Patients Above 3 Years

The preferred drug for treating absence seizures in patients above 3 is “valproate” (valproic acid). Many clinical studies have illustrated its efficacy in decreasing the frequency and duration of absence seizures. It has proven notably effective in managing typical and atypical absence seizures.

Valproate use has markedly enhanced the management and quality of life for individuals experiencing these seizures, making it the favored treatment option in this patient group.

Mechanism of Action

Valproate, also called valproic acid, is a medication for treating absence seizures. It functions by impacting a chemical known as gamma-aminobutyric acid (GABA) in the brain. GABA represents a natural substance that assists in calming the brain’s electrical activity. Valproate raises GABA levels in the brain by inhibiting its degradation.

This action helps cut the abnormal electrical activity responsible for absence seizures. In simpler terms, Valproate aids in soothing the brain and preventing seizures.

Dosage Guidelines

The initially suggested dosage for Valproate is 15 mg/kg daily, split into two or three equal doses. This starting dosage is typically increased gradually by 5-10 mg/kg weekly until the desired effect is reached. The maximum dosage generally falls between 30-60 mg/kg daily. 

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Side Effects of Valproate

More Common and Less Severe Side Effects

• Nausea: Sensation of sickness in the stomach, often accompanied by an urge to vomit.
• Vomiting: Stomach contents being ejected firmly through the mouth.
• Abdominal Pain: Discomfort or cramping in the area of the stomach.
• Dizziness: Sensation of lightheadedness or unsteadiness.
• Drowsiness: Excessive tiredness or sleepiness.
• Tremor: Involuntary shaking or trembling in hands, arms, legs, or other body parts.
• Hair Loss: Thinning or hair loss, reversible upon medication discontinuation.
• Weight Gain: Gradual increase in body weight.

Less Common and More Severe Side Effects

• Liver Toxicity: Valproate can cause liver damage on rare occasions. It results in symptoms such as yellowing skin or eyes, dark urine, or abdominal pain. Regular liver function monitoring is usually recommended.
• Pancreatitis: Inflammation of the pancreas, characterized by severe abdominal pain, nausea, and vomiting. This rare but serious side effect requires immediate medical attention.
• Blood Disorders: Valproate may cause changes in blood cell counts. It can increase the risk of infections, easy bruising or bleeding, or fatigue.
• Allergic Reactions: Some individuals might experience allergic reactions to Valproate. It presents as skin rashes, itching, swelling of the face or throat, or difficulty breathing. 
• Mood and Behavioral Changes: Valproate has links to mood swings, irritability, or worsening of depression in rare cases.
• Hormonal Effects: Valproate can also disrupt hormonal balance. It causes menstrual irregularities in women or changes in testosterone levels in men.

Contraindications

Valproate is contraindicated in specific situations due to potential risks linked to its use. Contraindications encompass:

• Pregnancy: Valproate poses a high risk of birth defects and developmental disorders during pregnancy. It should be avoided in females of childbearing age unless no suitable alternative treatments exist.
• Liver Disease: Valproate can cause liver damage, especially in patients with pre-existing liver disease. It should be used cautiously or avoided in individuals with liver issues.
• Hypersensitivity: Individuals with known hypersensitivity to Valproate or its components must not use this medication.

Drug of Choice for Absence Seizures in Patients Below 3 Years

The drug of choice for treating absence seizures in patients below 3 years of age is “Ethosuximide.” Ethosuximide has undergone thorough study and demonstrated notable effectiveness in controlling absence seizures, specifically in this age group. 

It is well-tolerated and possesses a favorable safety profile. Its use has markedly enhanced seizure management and the quality of life for young patients.

Mechanism of Action

Ethosuximide blocks specific channels in the brain’s cells called calcium channels. Doing this helps to stop the unusual electrical activity in the brain that causes absence seizures. Ethosuximide explicitly targets a part of the brain called the thalamus, which helps control our level of alertness. By regulating the calcium channels, Ethosuximide helps stabilize the brain’s activity and prevents the absence of seizures. In simpler terms, it helps calm the brain and stops the seizures.

Dosage Guidelines

The initial suggested dosage for Ethosuximide is 500 mg/day. A dose of more than 1500 mg/day divided into multiple doses should be only used under the supervision of your doctor.

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Side Effects of Ethosuximide

More Common but Less Severe Side Effects

• Stomach Pain: A feeling of discomfort or cramping in the stomach.
• Nausea: Feeling sick to the stomach, sometimes accompanied by the urge to vomit
• Vomiting: The forcefully expelling of the stomach’s contents through the mouth.
• Drowsiness: Feeling excessively tired or sleepy.
• Dizziness: Feeling lightheaded or unsteady.
• Loss of Appetite: A decreased desire to eat or a reduced interest in food.
• Headache: Unusual pain or discomfort in the head.

Less Common and More Severe Side Effects

• Allergic Reactions: Some individuals might experience allergic reactions to Ethosuximide, presenting as skin rashes, itching, swelling of the face or difficulty breathing.
• Mood and Behavioral Changes: Ethosuximide has links to mood swings, irritability, aggression, or worsening of depression or suicidal thoughts in some individuals.
• Blood Disorders: Ethosuximide may cause changes in blood cell counts infrequently, leading to an increased risk of infections, easy bruising or bleeding, or fatigue.
• Liver Problems: Ethosuximide can cause liver damage in rare cases. It causes yellowing of the skin or eyes (jaundice), dark urine, abdominal pain, or fatigue. Regular liver function monitoring is usually recommended.

Important! Always consult a healthcare professional for advice on Valproate or other medications. I am here for online consultation if you have concerns, questions, or medical conditions related to absence seizures or other health issues. Feel free to reach out and arrange an online consultation to obtain professional medical assistance.

Contraindications

• Hypersensitivity: Ethosuximide should not be used in patients with hypersensitivity or allergy to Ethosuximide.
• Liver Disease: Patients with pre-existing liver disease or impaired liver function should avoid using Ethosuximide, as it may exacerbate the condition. 
• Blood Disorders: Individuals with a history of blood disorders should exercise caution when considering Ethosuximide.
• Breastfeeding: Nursing mothers should avoid Ethosuximide, as it can pass into the breast milk and potentially affect the nursing infant. Consultation with a doctor is necessary to discuss alternative treatments or feeding options.

Final Words!

Selecting the suitable drug for treating absence seizures is essential in managing this condition effectively. For patients above 3 years of age, Valproate has shown its efficacy in treating absence seizures.

Conversely, for patients below 3 years of age, Ethosuximide has become the favored option due to its demonstrated effectiveness and favorable safety profile.

Grasping the mechanism of action, proper dosage guidelines, potential side effects, and contraindications of these medications are vital for optimal treatment.

By staying knowledgeable about the drug of choice for absence seizures, you can make informed decisions and create effective treatment plans, ultimately enhancing the quality of life.

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1. What is the best treatment for absence seizures?

Ethosuximide is often considered the first-line medication for absence seizures due to its effectiveness in controlling these specific seizure types.

2. What is the drug of choice for complex absence and tonic-clonic seizures?

Valproate is often considered the drug of choice for complex absence and tonic-clonic seizures. It is a broad-spectrum antiepileptic medication that can effectively manage both seizure types, providing comprehensive seizure control for individuals experiencing these seizure manifestations.

3. Is diazepam used for absence seizures?

Diazepam is not usually chosen as the initial treatment for absence seizures. It is mainly employed for managing acute seizures and is often given in urgent situations to halt extended seizures or status epilepticus. Ethosuximide or Valproate are typically favored for long-term management of absence seizures.

4. What is the first-line drug of choice for focal seizure?

The primary drug selected for focal seizures, also called partial seizures, relies on various factors. Some common factors include the particular type of focal seizure, the patient’s age, and individual medication response. Levetiracetam, lamotrigine, and carbamazepine are frequent first-line choices.

5. What is the emergency medication for seizures in children?

Midazolam is the emergency medication often used for seizures in children. It can be given in multiple forms, like nasal spray, rectal gel, or intranasal solution. It is specifically utilized to cease ongoing seizures or status epilepticus in urgent situations.