An 8-year-old girl has multiple daily episodes of brief staring with cessation of activity, each lasting about 10 seconds. EEG shows generalized 3 Hz spike-and-wave discharges provoked by hyperventilation. Which drug is preferred as initial monotherapy?

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

Explanation

Childhood absence epilepsy with classic 3 Hz generalized spike-and-wave discharges responds best to ethosuximide, which blocks T-type calcium channels in thalamic neurons and was superior to valproate for seizure control with fewer cognitive side effects in comparative trials. Carbamazepine, phenytoin, and gabapentin are sodium channel or other agents that can worsen absence seizures, which makes them actively inappropriate here.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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