What is the first-line treatment for absence seizures?

Absence seizures are a specific type of seizure characterized by brief episodes of impaired consciousness, often precipitated by hyperventilation or flashing lights. The first-line treatment for absence seizures is ethosuximide. This medication is particularly effective in managing this type of seizure because it specifically targets the T-type calcium channels in thalamic neurons that are involved in the generation of absence seizures. Ethosuximide helps to reduce the frequency and severity of these seizures by decreasing the excitability of the neurons responsible for them.

In contrast, medications such as phenytoin and carbamazepine are not typically effective for treating absence seizures and may even worsen the condition. Valproate is another option that can be used for absence seizures, especially if there are atypical features or if the patient has multiple seizure types, but ethosuximide is preferred as the first-line treatment due to its targeted action and favorable side effect profile for this specific type of seizure. Therefore, ethosuximide is the most appropriate choice for the initial management of absence seizures.