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Therapeutic Options for Childhood Absence Epilepsy
Victoria Elisa Rinaldi1, Giuseppe Di Cara2, Elisabetta Mencaroni2
1Pediatric Unit, San Giovanni Battista Hospital, 06034 Foligno, Italy.
Insights
Childhood absence epilepsy (CAE) is a common pediatric epilepsy. Recent studies show CAE can cause lasting neurocognitive issues and drug-resistant epilepsy, necessitating updated treatment strategies beyond traditional antiepileptic drugs.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Childhood absence epilepsy (CAE) is a prevalent pediatric generalized epileptic syndrome.
- Traditionally viewed as benign, CAE is now recognized for potential invalidating neuropsychological comorbidities extending into adulthood.
- A subset of children with CAE may develop drug-resistant epilepsy.
Purpose of the Study:
- To review recent studies and emerging concepts in the management of Childhood absence epilepsy.
- To focus on novel treatment strategies for drug-resistant forms of CAE.
Main Methods:
- A comprehensive literature search was conducted on Pubmed.
- The search included articles on the management and treatment of CAE published between 1979 and 2021.
Main Results:
- Established first-line treatments for CAE include ethosuximide, valproic acid, and lamotrigine.
- Treatment failure may lead to combination therapy (bi-therapy).
- For refractory absence seizures, alternative antiepileptic drugs like levetiracetam, topiramate, and zonisamide are considered.
Conclusions:
- The understanding of Childhood absence epilepsy has evolved, highlighting its potential long-term impact.
- Treatment approaches for CAE, especially drug-resistant cases, require ongoing evaluation and adaptation.
- Further research into novel therapeutic options for refractory CAE is warranted.
Abstract:
Childhood absence epilepsy (CAE) is a common pediatric generalized epileptic syndrome. Although it is traditionally considered as a benign self-limited condition, the apparent benign nature of this syndrome has been revaluated in recent years. This is mainly due to the increasing evidence that children with CAE can present invalidating neuropsychological comorbidities that will affect them up to adulthood. Moreover, a percentage of affected children can develop drug-resistant forms of CAE. The purpose of this review is to summarize the most recent studies and new concepts concerning CAE treatment, in particular concerning drug-resistant forms of CAE. A Pubmed search was undertaken to identify all articles concerning management and treatment of CAE, including articles written between 1979 and 2021. Traditional anticonvulsant therapy of CAE that is still in use is based on three antiepileptic drugs: ethosuximide which is the drug of choice, followed by valproic acid and lamotrigine. In the case of first line treatment failure, after two monotherapies it is usual to start a bi-therapy. In the case of absence seizures that are refractory to traditional treatment, other antiepileptic drugs may be introduced such as levetiracetam, topiramate and zonisamide.
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