Ethosuximide prevented seizures in 53 percent of the children, slightly less than the 58 percent freedom-from-failure rate of valproic acid but significantly better than the 29 percent for lamotrigine. But only 33 percent of those taking the older drug had significant attention problems, compared to 49 percent of those taking valproic acid, the researchers found.
So the treatment strategy indicated by the study -- and now being followed in Cincinnati -- is to start with ethosuximide, Glauser said. "If it hasn't worked after four or five months, you need to switch medicines," he said, with a trial of valproic acid. If that doesn't work, either lamotrigine or a combination of drugs should be used. More than 90 percent of children respond to one of the regimens, Glauser added.
"It was somewhat unexpected that the oldest of the drugs had as good an effect as the other and better side effects," said study participant Dr. Shlomo Shinnar, director of the Comprehensive Epilepsy Management Center at the Children's Hospital of Montefiore Medical Center in New York City.
"The study highlights the importance of looking not only at seizure control but also how the child does otherwise," Shinnar said. "You want seizure control without side effects, such as problems with attention and behavior."
"Unfortunately, even our best medications work only half the time," Glauser noted. "We need to develop better medications or better algorithms to match children with medicines better."
But with proper treatment, most children with the condition "go on to lead good, fulfilling lives," Glauser said.
A guide to dealing with childhood epilepsy is given by t
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