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Childhood Absence Epilepsy — RACP Paediatrics MCQ

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ModerateNeurology & DevelopmentChildhood Absence EpilepsyRACP Paediatrics

A 9-year-old boy presents with brief episodes of staring and unresponsiveness lasting 5–10 seconds, occurring multiple times per day. His teacher reports he 'zones out' in class. There is no post-ictal confusion. EEG shows 3 Hz generalised spike-and-wave discharges activated by hyperventilation. What is the first-line treatment?

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Correct answer: E — Sodium valproate or ethosuximide

Childhood absence epilepsy is characterised by brief absence seizures with 3 Hz generalised spike-and-wave on EEG, provoked by hyperventilation. First-line treatment is either ethosuximide (if absences only) or sodium valproate (if generalised tonic-clonic seizures also occur). Carbamazepine is contraindicated as it may worsen absence seizures.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Epilepsy