An 8-year-old girl has frequent brief staring spells with eyelid fluttering, each lasting about 10 seconds, with immediate return to full awareness. EEG shows generalized 3 Hz spike-and-wave discharges provoked by hyperventilation. Which drug is the best initial monotherapy?

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

Explanation

Ethosuximide is the preferred initial drug for childhood absence epilepsy, acting by blockade of T-type calcium channels in thalamic neurons. Carbamazepine, phenytoin, and gabapentin are sodium-channel or alpha-2-delta acting agents that are effective against focal seizures but can worsen absence seizures and may precipitate absence status. Valproate or lamotrigine are alternatives when generalized tonic-clonic seizures coexist.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.