A 6-year-old girl has 10–20 brief (5–10 second) staring spells daily. During an episode, she has subtle eyelid fluttering and does not respond. She recovers immediately with no postictal confusion. EEG shows 3 Hz generalized spike-and-wave discharges. Which drug is CONTRAINDICATED in this type of epilepsy?
- A Valproate
- B Ethosuximide
- C Carbamazepine ✓
- D Lamotrigine
Explanation
This is childhood absence epilepsy (CAE), characterized by brief frequent absence seizures with 3 Hz generalized spike-and-wave EEG. First-line treatments include ethosuximide (drug of choice, especially if no generalized tonic-clonic seizures), valproate, and lamotrigine. Carbamazepine (and oxcarbazepine, phenytoin) are sodium channel blockers effective for focal-onset and generalized tonic-clonic seizures but are CONTRAINDICATED in generalized absence epilepsy — they paradoxically worsen absence seizures and can precipitate absence status epilepticus. This is an important distinction that is frequently tested.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.