title: Long-term seizure remission in childhood absence epilepsy: might initial treatment matter?
abstract: OBJECTIVE
  Examine the possible association between long-term seizure outcome in childhood absence epilepsy (CAE) and the initial treatment choice.
  
  
  METHODS
  Children with CAE were prospectively recruited at initial diagnosis and followed in a community-based cohort study. Children presenting with convulsive seizures, significant imaging abnormalities, or who were followed <5 years were excluded. Early outcomes included success of initial medication, early remission, and pharmacoresistance. The primary long-term outcome was complete remission: ≥5 years both seizure free and medication free. Survival methods were used for analyses.
  
  
  RESULTS
  The first medication was ethosuximde (ESM) in 41 (69%) and valproic acid (VPA) in 18 (31%). Initial success rates were 59% (ESM) and 56% (VPA). Early remission and pharmacoresistance were similar in each group. Apart from atypical electroencephalography (EEG) features (61% [VPA], 17% [ESM]), no clinical features varied substantially between the treatment groups. Complete remission occurred in 31 children (76%) treated with ESM and 7 (39%) who received VPA (p = 0.007). Children with versus without atypical EEG features were less likely to enter complete remission (50% vs. 71%, p = 0.03). In a Cox regression, ESM was associated with a higher rate of complete remission than VPA (hazards ratio [HR] 2.5, 95% confidence interval [CI] 1.1-6.0; p = 0.03). Atypical EEG features did not independently predict outcome (p = 0.15). Five-year and 10-year remission, regardless of continued treatment, occurred more often in children initially treated with ESM versus VPA.
  
  
  CONCLUSIONS
  These findings are congruent with results of studies in genetic absence models in rats and provide preliminary evidence motivating a hypothesis regarding potential disease-modifying effects of ESM in CAE. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
authors: Department of Pediatrics, Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A; the Northwestern Memorial Feinberg School of Medicine, Chicago, Illinois, U.S.A.
authors: Anne T
authors: AT
authors: Berg
authors: Susan R
authors: SR
authors: Levy
authors: Francine M
authors: FM
authors: Testa
authors: Hal
authors: H
authors: Blumenfeld
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004569:Electroencephalography / Q000639:trends; D004832:Epilepsy, Absence / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012074:Remission Induction; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Absence seizures; Antiepileptic drugs; Cohort studies; Comparative effectiveness; Disease modification