Drugs used to treat absences (petit mal)

Ethosuximide is only effective in the treatment of absences

and myoclonic seizures (brief jerky movements without loss of
consciousness). It is widely used as an anti‐absence drug because
it has relatively mild adverse effects (e.g. nausea, vomiting).

Topiramate blocks sodium channels in cultured neurones.

It also enhances the effects of GABA and blocks α‐amino‐3‐
hydroxy‐5‐methyl‐4‐isoxazolepropionic acid (AMPA) receptors.
Adverse effects include nausea, abdominal pain and anorexia.
Topiramate has been associated with acute myopia and secondary
closed‐angle glaucoma.
Phenobarbital is probably as effective as carbamazepine and
phenytoin in the treatment of tonic–clonic and partial seizures,
but it is much more sedative. Tolerance occurs with prolonged
use and sudden withdrawal may precipitate status epilepticus.
Vigabatrin, gabapentin, levetiracetam, pregabalin and
tiagabine are used as ‘add‐on’ drugs in patients in whom epilepsy
is not satisfactorily controlled by other antiepileptics. Gabapentin
(and carbamazepine) are also used to relieve shooting and stabbing
neuropathic pain that responds poorly to conventional analgesics.

Drug withdrawal
Abrupt withdrawal of antiepileptic drugs can cause rebound
seizures. It is difficult to know when to withdraw antiepileptics
but, if a patient has been seizure‐free for 3 or 4 years, gradual
withdrawal may be tried..