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Reproduced with permission from Hadjiloizou SM, Bourgeois BFD. Antiepileptic drug treatment in children. Expert Rev Neurotherapeutics. 2007;7:179-193.
would be valproic acid (VPA), lamotrigine years and those above the age of 10 years. years with absence seizures, when an AED
(LTG), levetiracetam (LEV), or topiramate There are at least 3 reasons for this: (1) con- needs to be introduced or changed, the choice
(TPM) because of the available evidence. Carba- comitant GTCS are more likely to occur after would be valproic acid (VPA). It is quite safe
mazepine (CBZ), phenytoin (PHT), or zonisam- the age of 10 years in patients diagnosed with in monotherapy at this age and highly effective
ide (ZNS), which are potentially effective, could CAE, and are common in JAE; (2) the inci- against GTCS, whereas ESM offers no such
be considered as further choices, but CBZ and dence of VPA-induced fatal hepatotoxicity is protection. LTG, which is also effective against
PHT should be avoided if an idiopathic general- highest in infants and young children, espe- absence seizures and GTCS, is quite safe in this
ized epilepsy is suspected. cially in combination therapy; and (3) the in- age group and is a valuable alternative to VPA,
cidence of severe hypersensitivity reaction especially in adolescent girls.
associated with LTG also appears to be in-
■ ABSENCE EPILEPSIES: CHILDHOOD versely age related. Consequently, Ethosuxi-
AND JUVENILE ABSENCE EPILEPSY mide (ESM) may still represent the drug of ■ JUVENILE MYOCLONIC
(CAE AND JAE) first choice in patients younger than 10 years EPILEPSY (JME)
Children with absence seizures may be divided old who have only absence seizures, as is usu- Valproic acid (VPA) remains a drug of choice
into 2 age categories: those under the age of 10 ally the case in CAE. In any child older than 10 for JME. However, the side-effect profile of