A 22-year-old woman has episodes of blank staring lasting 10 seconds many times a day, with no postictal confusion. EEG shows 3 Hz spike and wave. Which drug is first-line?
Answer and explanation
Correct answer: C. Ethosuximide or sodium valproate, with valproate avoided in women of childbearing potential
- Step 1: This is absence epilepsy.
- Step 2: Ethosuximide is first-line, and valproate must be avoided in people who may become pregnant because of teratogenicity.
Answer
Ethosuximide or sodium valproate, with valproate avoided in women of childbearing potential.
Why not the others: Phenytoin as first-line treatment, with levels checked every month: Phenytoin is not first-line. Gabapentin as monotherapy, titrated to the maximum licensed dose: Gabapentin is not licensed for absences. Carbamazepine as first-line treatment for all patients with generalised seizures: Carbamazepine can worsen absence seizures.
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