A 9-year-old girl has multiple daily episodes of sudden cessation of activity lasting about 10 seconds, with eyelid fluttering and immediate return to awareness, several times a day. EEG shows generalized 3 Hz spike-and-wave discharges provoked by hyperventilation. First-line therapy is:
- A Phenytoin
- B Ethosuximide ✓
- C Levetiracetam as second line after carbamazepine fails
- D ACTH
Correct answer: B. Ethosuximide
Explanation
Brief staring spells with abrupt onset and offset, 3 Hz spike-and-wave on hyperventilation, define childhood absence epilepsy. Comparative trials place ethosuximide first line, with valproate equally effective but more toxic. Phenytoin and carbamazepine act on sodium channels and can exacerbate absence seizures, so option C embeds a wrong premise. ACTH is reserved for infantile spasms.
Reference: Nelson Textbook of Pediatrics, 22nd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.