Absence epilepsy: Older vs newer AEDs

Over the last one to two decades, several new antiepileptic drugs (AEDs) have become available. These medications have different mechanisms of action, metabolism, efficacy, and side effect profiles. Hence, it has become possible to customize medications for a particular patient. It has also become possible to use various combinations of treatments for refractory epilepsies. As medication options have increased, our goal has shifted to not only to maximize seizure control but also to minimize side effects. However, the older AEDs are still widely used. So the question arises - are newer medications better than older AEDs for the treatment of absence epilepsy? Based on a large multicenter class I study, older AEDs - ethosuximide and valproic acid - are more efficacious than newer AEDs. Due to reduced side effects, ethosuximide remains the first line treatment for childhood absence epilepsy.