1. Potera, Carol


A comparative drug study clears up some mystery.


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Authors of a recent (and rare) randomized, double-blind, comparative trial of three common antiepilepsy drugs conclude that "ethosuximide, one of the oldest available antiseizure medications, is a sensible choice for initial empirical monotherapy in childhood absence epilepsy." Ethosuximide (Zarontin) beat out valproic acid (Depakote) and lamotrigine (Lamictal). [Editor's note: According to the manufacturers of Depakote, "Divalproex sodium is a compound that contains sodium valproate and valproic acid." The study authors referred to the drug generically as valproic acid."]


Childhood absence (formerly known as petit mal) epilepsy is the most common type of epilepsy in children. Seizures look like staring spells or daydreaming and are often mistakenly perceived as benign, but affected children often have long-term cognitive deficits and psychosocial problems. In order to compare the three commonly used drugs with one another-none of which had previously been determined to be superior to the others-the Childhood Absence Epilepsy Study Group collected data at 32 sites across the United States.


Patients with newly diagnosed absence epilepsy were randomly assigned to take ethosuximide (155 children), lamotrigine (149 children), or valproic acid (147 children) for 16 weeks. The median age of the children was about 7.5 years. The medication dose was increased gradually until seizures stopped or the maximum allowable dose was reached. At 16 weeks, children treated with valproic acid had a freedom-from-failure (defined as being seizure free without adverse treatment effects) rate of 58%, followed by rates of 53% for ethosuximide and 29% for lamotrigine. Children taking ethosuximide performed slightly better on tests of attentional skills than those taking valproic acid. The researchers believe ethosuximide to be the superior initial therapy because it controlled seizures better than lamotrigine and was linked to fewer attentional deficits than valproic acid.


"It's a good news-bad news situation," says Peggy O. Clark, pediatric NP at Cincinnati Children's Hospital Medical Center and a study coauthor. "Even if you prescribe the best drug first, it still works only about half the time. We need better drugs in our arsenal," says Clark. She recommends starting with ethosuximide and then, if the drug proves ineffective, switching to valproic acid.


The study also revealed that electroencephalography (EEG) is necessary to confirm that children are seizure free. In the past, seizure status was documented only by parents' report and bedside hyperventilation testing, which induces seizures. "We thought this was sufficient to say kids are seizure free," Clark says. But in the study, EEG detected seizures in a significant number of children who had been deemed seizure free on the basis of parents' reports and hyperventilation tests.-Carol Potera




* 3,063,163: The number of licensed RNs living in the United States, as of March 2008, according to the Health Resources and Services Administration of the U.S. Department of Health and Human Services.


* 60% (23.2 million): The percentage of 39.4 million hospital admissions in 2007 that were women, according to the Agency for Healthcare Research and Quality. The primary reason for admission was childbirth (about 5 million hospital stays), and 2 million hospital stays were related to cardiovascular disease.


* 16%: The percentage of pregnant women who need to be treated for gestational diabetes, according to a report from the International Association of Diabetes and Pregnancy Study Groups, published in the March issue of Diabetes Care.


* 4,000: The daily number of children younger than 18 years who try their first cigarette, according to the Food and Drug Administration.



Glauser TA, et al. N Engl J Med 2010;362(9):790-9.