Ethosuximide is recommended as first line treatment for childhood absence epilepsy (CAE)1. It has been found to be more effective than Lamotrigine and to have fewer side effects than Lamotrigine and Valproate2.
Objective The aim of this study was to assess the efficacy and tolerability of Ethosuximide in children.
Methods The notes of all patients attending a tertiary Paediatric Neurology clinic who were prescribed Ethosuximide over a 5 year period (January 2008 to January 2013) were requested. The duration of treatment with Ethosuximide, the reason for discontinuation and any side effects were recorded.
Results Fifty-three patients were prescribed Ethosuximide. Notes could be retrieved in 51 patients and sufficient detail about the treatment with Ethosuximide was available in 46, 25 of them female. In 22/46 (48%) Ethosuximide was prescribed for CAE; in the remaining it was used as an add-on drug for other epilepsies. The mean age at commencing treatment was 8..1 years. The median duration of treatment with Ethosuximide was 6 months (range 171 months). Thirty-four children (74%) discontinued treatment with Ethosuximide, 18 because of treatment failure, 10 due to side effects and in 6 patients both. The commonest side effects were vomiting and abdominal pain; worsening behaviour, nightmares, rashes and drowsiness were also encountered. In CAE it was discontinued in 8/22 (36%) because of a lack of efficacy, and 6/22 (27%) because of side-effects.
Conclusion The usefulness of Ethosuximide in treating epilepsy in this group of patients is limited by its efficacy and tolerability. This differs from the good retention and side-effect profile reported for this anticonvulsant drug (AED). It might be worth reviewing these findings on a larger scale to define this more precisely, as our experience with this AED would suggest that it has a limited utility as a first-line agent.
NICE clinical guideline 137, The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care, Issued: January 2012
Glauser TA, Cnaan A, Shinnar S et al., Ethosuximide, Valproic Acid, and Lamotrigine in Childhood Absence Epilepsy, N Engl J Med 2010;362:790–9.