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Absence Plus GTC Treatment — RACP Paediatrics MCQ

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ModerateNeurology & DevelopmentAbsence Plus GTC TreatmentRACP Paediatrics

A 10-year-old presents with absence seizures that have been well controlled on ethosuximide. She now has her first generalised tonic-clonic seizure. What medication change should be made?

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Correct answer: D — Switch to or add sodium valproate (which covers both absence and GTC seizures)

Ethosuximide is effective only for absence seizures. When GTCs develop, a broad-spectrum ASM is needed. Sodium valproate covers both absence and GTC seizures and is the drug of choice for this scenario (or lamotrigine if valproate is contraindicated). Carbamazepine/phenytoin can worsen absence seizures.

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