Which medication is considered second-line for absence seizures after Ethosuximide?

• A. Valproic acid
• B. Ethosuximide
• C. Lamotrigine
• D. Clonazepam

Answer: (A)

Absence seizures respond best to Ethosuximide as the initial therapy. If a second option is needed after Ethosuximide, Valproic acid is the most appropriate choice because it has strong efficacy for absence seizures and can also address generalized tonic-clonic seizures if they occur. However, its use is limited by serious safety concerns—hepatotoxicity, teratogenicity, and potential drug interactions—so it’s typically reserved for patients who need broader seizure control or who do not respond fully to Ethosuximide. Lamotrigine can be useful in some cases but is generally less reliable for pure absence seizures and requires careful titration to avoid rash. Clonazepam is usually adjunctive due to sedative effects and dependency risks.