A 5-year-old boy has recurrent episodes of brief staring spells lasting 5–10 seconds, with subtle eye blinking and no postictal confusion. EEG shows 3 Hz generalized spike-and-wave discharges on hyperventilation. Family history reveals his older sister has childhood absence epilepsy. What is the drug of CHOICE for this condition?
- A Ethosuximide ✓
- B Valproate
- C Levetiracetam
- D Clonazepam
Explanation
Childhood absence epilepsy (CAE) is treated with ethosuximide as the drug of first choice due to its specific efficacy against T-type calcium channels (which mediate the 3 Hz spike-wave oscillations) and its favorable cognitive/behavioral profile compared to valproate. A multicenter RCT (CHITIKA trial) confirmed ethosuximide is superior to valproate for attentional side effects while having equivalent seizure control. Valproate is a second choice or used when generalized tonic-clonic seizures co-exist. Levetiracetam is not approved as monotherapy for CAE. Ethosuximide does NOT protect against generalized tonic-clonic seizures.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.