Related Experiment Videos
[Problems surrounding absence seizures]
1Department of Pediatrics, Nippon Medical School Second Hospital, Kanagawa.
Insights
Childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE) treatments vary, with valproic acid as a primary option. While absence seizures may resolve, long-term prognosis indicates potential for generalized tonic-clonic seizures and social challenges.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Context:
- Childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE) are distinct epilepsy syndromes.
- Understanding the differences in onset, clinical features, and EEG findings is crucial for accurate diagnosis.
- The age demarcation between CAE and JAE remains a topic of discussion.
Purpose:
- To review the diagnosis, treatment, and prognosis of CAE and JAE.
- To analyze treatment responses and long-term outcomes in a cohort of 94 patients.
- To provide insights into the clinical course and social impact of these epilepsy types.
Summary:
- Valproic acid is the first-line treatment for CAE, with ethosuximide or clonazepam as add-on therapies.
- Lamotrigine shows efficacy when combined with valproic acid.
- While absence seizures often cease by adulthood, generalized tonic-clonic seizures can emerge, impacting social prognosis.
Impact:
- This review offers guidance on optimal pharmacotherapy for absence epilepsies.
- It highlights the importance of long-term monitoring for seizure recurrence and evolution.
- Findings suggest that the social prognosis for individuals with CAE and JAE may require more comprehensive support than previously assumed.
Abstract:
The diagnosis, treatment, and prognosis of childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE) were reviewed with reference to 94 patients with typical absence seizures (82 with CAE, 12 with JAE) and the literature. The patients were separated into two groups based on clinical features, age at onset of seizures, and EEG findings. There has been much discussion on the age that represents the borderline between CAE and JAE. My view is that JAE begins with puberty, i.e. at around 10 years old. The treatment of choice for CAE is valproic acid (VPA). If the seizures are not controlled with VPA, add-on therapy with ethosuximide is recommended. For patients who respond poorly to these drugs, clonazepam in often effective. Lamotrigine, which is not yet commercially available in Japan, is effective when combined with VPA. As for school performance, some patients showed excellent results. However, about half of them performed weakly. Patients followed beyond 20 years were free of absence seizures in both groups, but suffered from GTCS with occurred sporadically in CAE as well as in JAE. The social prognosis in CAE and JAE may not be as good as we believed it to be.