A 7-year-old boy has multiple daily episodes of brief staring with fluttering eyelids, each lasting about 10 seconds, with immediate return to full awareness. EEG shows generalised 3 Hz spike-and-wave discharges provoked by hyperventilation. Which drug is the best initial choice?

• A Carbamazepine
• B Phenytoin
• C Gabapentin
• D Ethosuximide ✓

Explanation

This is childhood absence epilepsy. Ethosuximide, which blocks T-type calcium channels in thalamic neurons, is preferred over valproate as initial monotherapy because of comparable efficacy with fewer cognitive and systemic adverse effects. Carbamazepine, phenytoin, and gabapentin are sodium channel or other agents effective against focal seizures but can worsen absence seizures, making them actively harmful choices here.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.