This page covers the single and add-on anti-seizure medication options for treating absence seizures, and absence seizures with other seizures.
On this page
First single anti-seizure medication option
The first single anti-seizure medication tried for absence seizures is ethosuximide (Zarontin and other brand names).
Second single anti-seizure medication option or add-on
If the first treatment doesn’t work, sodium valproate (Epilim and other brand names) can be tried as the second single anti-seizure medication or as an add-on treatment for absence seizures in:
- Boys of all ages
- Girls aged under 10 unlikely to need treatment when they’re old enough to have children
- Women who can’t have children
However, there are new rules that apply to valproate treatments (see more information below). The treatment recommendations from NICE (the National Institute for Health and Care Excellence) that relate to valproate are currently being reviewed.
Third single anti-seizure medication option or add-on
If sodium valproate (Epilim and other brand names) doesn’t work, the following can be tried as third single anti-seizure medication options or as add-on treatments:
- Lamotrigine (Lamictal and other brand names) or
- Levetiracetam (Keppra and other brand names)
If the first choice doesn’t work, the second will be tried.
First treatment options for absence seizures with other seizure types
Sodium valproate (Epilim and other brand names) can be tried as first single anti-seizure medication for absence seizures with other seizure types, or when there’s a risk of these, in:
- Boys and men
- Girls aged under 10 unlikely to need treatment when they’re old enough to have children
- Women who can’t have children
However, there are new rules that apply to valproate treatments (see more information below). The treatment recommendations from NICE (the National Institute for Health and Care Excellence) that relate to valproate are currently being reviewed.
In women and girls who can have children, including young girls likely to need treatment when they’re old enough to have children, who have absence seizures with other seizure types, or when there’s a risk of these, the following can be tried as a first option:
- Lamotrigine (Lamictal and other brand names) or
- Levetiracetam (Keppra and other brand names)
If the first choice doesn’t work, the second will be tried.
Sodium valproate (Epilim and other brand names) should not be tried for absence seizures with other seizure types (or a risk of these) in women and girls who can have children, including young girls likely to need treatment when they’re old enough to have children, unless:
- Other treatments don’t work
- The benefits and risks have been fully discussed, including the risks to an unborn child
- The likelihood of pregnancy has been taken into account and a pregnancy prevention programme is in place, if appropriate
There are new rules that apply to valproate treatments (see more information below). The treatment recommendations from NICE (the National Institute for Health and Care Excellence) that relate to valproate are currently being reviewed.
Sodium valproate
In January 2024, new rules were introduced for prescribing sodium valproate.
Two specialists are now needed to approve:
- New or ongoing valproate treatments for girls and women.
- New valproate treatments for boys and men
The specialists must agree that your epilepsy does not respond to other treatments and the benefits of treatment outweigh the risks.
For girls and women, valproate can seriously harm an unborn baby when taken during pregnancy.
For boys and men, valproate may cause infertility. Some people’s fertility may return when their treatment is stopped or reduced. There is also some evidence that valproate can cause harm in the testicles of animals, but it’s unclear what this means for humans.
Never stop taking valproate before talking to your specialist first. Not taking medication as prescribed can increase the risk of a seizure.
Your epilepsy specialist will let you know when your treatment is due to be reviewed.
If you are planning a pregnancy it is important to speak to your healthcare professional as soon as possible about your treatment options.
If you have any questions or concerns about valproate, please speak to your healthcare professional.
Find out more about sodium valproate in the MHRA’s patient guide.
Find out more about Anti-seizure medications, contraception and pregnancy.
Second treatment options for absence seizures with other seizure types
If none of the first options work for absence seizures with other seizure types (or who are at risk of these), the following can be tried as second treatment options:
- Lamotrigine (Lamictal and other brand names) or levetiracetam (Keppra and other brand names) as a second single anti-seizure medication or as add-on treatment options
- Ethosuximide as a second add-on treatment
If the first choice doesn’t work, the second done can be tried.
Switching from the first to second or third single anti-seizure medication
During the switch from the first single anti-seizure medication to the second option:
- The dose of the first anti-seizure medication remains the same while the dose of the second is increased slowly
- If the second anti-seizure medication works, the dose of the first will be slowly tapered off
- If the second anti-seizure medication doesn’t work, the dose will be slowly tapered off and a third option considered
Switching to using add-on anti-seizure medications
When starting an add-on treatment, the dose will be managed carefully and reviewed frequently.
This will include monitoring for side effects such as feeling sedated.
If add-on treatments don’t reduce seizures, epilepsy specialists will aim for the combination of anti-seizure medications that is the most effective while and has tolerable side effects.
Epilepsy specialists will discuss with the person, and their family or carers, as appropriate, the benefits of taking as few medicines as possible for seizure freedom or control.
Anti-seizure medications that may make seizures worse
The following anti-seizure medications may make seizures worse in people with absence seizures, and in people with absence seizures and other seizure types (or who are at risk of these):
- Carbamazepine (Tegretol and other brand names)
- Gabapentin (Neurontin and other brand names)
- Oxcarbazepine (Trileptal and other brand names)
- Phenobarbital (Luminal and other brand names)
- Phenytoin (Dilantin and other brand names)
- Pregabalin (Lyrica and other brand names)
- Tiagabine (Gabitril)
- Vigabatrin (Sabril)
