What is the first-line pharmacotherapy for a 7-year-old child with newly diagnosed absence seizures (petit mal) showing classic 3-Hz spike-and-wave discharges on EEG?
Answer and explanation
Correct answer: B. Ethosuximide
- Step 1: Ethosuximide is the first-line medication for pure childhood absence epilepsy.
- Step 2: It acts by blocking T-type low-voltage-activated calcium channels in thalamic neurons, suppressing the rhythmic 3-Hz generalized spike-and-wave paroxysms without sedative side effects.
- Step 3: Valproate is an alternative, especially if generalized tonic-clonic seizures coexist.
Answer
Ethosuximide.
Why not the others: 'Carbamazepine' and 'Phenytoin' can exacerbate absence seizures and are contraindicated; 'Phenobarbital' is used in neonatal seizures and generalized status epilepticus but causes cognitive blunting.
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