A 9-year-old girl has frequent brief lapses of awareness lasting a few seconds with staring and eyelid fluttering. EEG shows generalized 3 Hz spike-and-wave discharges provoked by hyperventilation. What is the drug of first choice?
- A Gabapentin
- B Phenytoin
- C Ethosuximide ✓
- D Carbamazepine
Correct answer: C. Ethosuximide
Explanation
This is childhood absence epilepsy. Ethosuximide, valproate, and lamotrigine are effective, but the landmark comparative trial showed ethosuximide gives the best combination of seizure freedom with fewest attentional adverse effects, making it first line for pure absence seizures. Carbamazepine, phenytoin, and gabapentin are sodium-channel or other agents that can worsen absences and may precipitate absence status, so they are contraindicated here.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.