A 6-year-old boy has multiple daily episodes of brief staring with eyelid fluttering. EEG shows 3 Hz generalized spike-and-wave discharges. He is otherwise neurologically normal. Which drug is the preferred first-line monotherapy?
- A Phenytoin
- B Carbamazepine
- C Ethosuximide ✓
- D Gabapentin
Correct answer: C. Ethosuximide
Explanation
The picture is childhood absence epilepsy. Comparative trials showed ethosuximide superior to valproate for absence seizures with fewer cognitive and cosmetic adverse effects, making it the drug of choice in children without concurrent generalized tonic-clonic seizures. Carbamazepine, phenytoin and gabapentin are sodium-channel or alpha2delta acting agents that do not suppress thalamocortical oscillations and can worsen absences.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.