Old drug may be first choice for childhood petit mal epilepsy
Effectiveness and modest side effects tilt comparison toward ethosuximide
By Nathan Seppa
In a three-way test, a 50-year-old drug has edged out two newer ones for treatment of a kind of epilepsy that causes children to gaze off into space.
The new study provides much-needed data for doctors, since all three medications have been used for years without being compared against one another in a controlled trial. The drug that came out on top, ethosuximide, gave the best balance of effectiveness and side effects, researchers report in the March 4 New England Journal of Medicine.
In the aptly named childhood absence epilepsy, or petit mal epilepsy, a child stops in the middle of an activity and stares blankly for 15 seconds or longer. “You can’t snap them out of it,” says study coauthor Tracy Glauser, a pediatric neurologist at the University of Cincinnati College of Medicine and Cincinnati Children’s Hospital. ”The kid is just like a statue.” Although appearing frozen, such a child is undergoing “an electrical storm on the surface of the brain,” he says.
The top three drugs prescribed for childhood absence epilepsy are ethosuximide (also sold as Zarontin), valproate (Depakote), and lamotrigine (Lamictal). Glauser and his colleagues randomly assigned 453 children with this form of epilepsy to receive one of these drugs for several months. The children ranged in age from 2 to 13 years and were seen at 32 medical centers across the United States.