Essay: Freedom from treatment failure

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After 12 months amantadine had the highest percentage free from treatment failure (79%).(Scott Perry). In Glauser et al. (2013) 53% treated with ethosuximide was free from treatment failure, 58% in valproic acid and 29 % in lamotrigine .

At 24 months ethosuximide had a free from failure rate of 75%, valproic acid had 67.8 and lamotrigine had 66.7. However there was no significant difference between the freedom- from- treatment failure rates for ethosuximide, lamotrigine and valproic acid.

The other drug therapy were not measured at 24 months.

The common reasons for treatment failure were lack of seizure control and intolerable side effects .

Drug therapy , onset and long-term effects

The follow-up ranged from 14 days to 2 years. The onset of efficacy was faster for Ethosuximide compared with valproic acid and lamotrigine( see follow up Gauser et al. 2010+2013)

The long-term treatment of ethosuximide , valproic acid and lamotrigine are equally effective.

Seizure free

Children treated with either ethosuximide of valproic acid had higher seizure free rates(respectively 87 and 75) than those treated with lamotrigine.(64)

The percentage seizure free in topiramate was lowest.(33)

Adverse events (see table 3)

All studies described types of adverse events after drug therapy.

Valproic acid

A. Glauser et al. discovered the valproic acid cohort experienced a higher rate of adverse events than in the ethosuximide cohort. Attentional dysfunction was more common with valproic (49%) acid than with ethosuximide persisted at 12 months (33%) p=0,03. The increase in BMI was an adverse event leading to discontinuation of the treatment in the cohort of valproic.( glauser 2013).

Lamotrigine

Holmes et al. described headache and cough after using lamotrigine. About 10% of patients using lamotrigine has a significant risk of rashes , and therefore it is recommended to increase the dose very slow. This may decrease the patients’ apllience.

The adverse events were lowest in amantadine and levetiractam. Topiramate was remarkably high.(67%)

The other drugs had no specific adverse events.

6. Conclusion/discussion

The onset of seizure control in ethosuximide is faster compared with valproic acid or lamotrigine. (7)Ethosuximide and valproic acid were more effective than lamotrigine, but ethosuximide resulted in fewer attentional effects as compared with valproic acid.

There were no significant differences among the three drugs with regard to discontinuation because of adverse events.

The long-term efficacy showed that ethosuximide, valproic acid and lamotrigine were equally efficacious. The newer drugs; levetiractam, amantadine and topiramate are also a possibility for treatment, but data is limited.

Overall the first choice drug therapy for children with absence seizures is ethosuximide.

Limitations and recommendations

Direct comparison of drugs was challenging because of the different study population, different study designs and relative small number of patients. Also the follow up time was different in the researches. This review considered only 12 months and 24 months follow up time to compare, with the exception of Fattore et al. in which the follow-up time was 14 days. This is quite short to determine a real effect.

Furthermore most studies contained information about the …

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