MEDizzy - A 5-year-old girl has frequent staring spells and does not

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Epilepsy and Seizures

A 5-year-old girl has frequent staring spells and does not respond when her mother calls her name during these episodes. She never falls down or bites her tongue, but she does have occasional lip smacking during episodes. EEG reveals a 3 Hz spike-and-wave pattern that occurs for less than 10 seconds at a time but several times an hour. The child has normal motor and cognitive development. Select the correct medication.

ExplanationD. This girl has generalized absence attacks. This may be a manifestation of a more complex epilepsy syndrome or may occur as an isolated finding. Generalized absence attacks have no aura and no postictal period. The affected child has no warning that an attack is about to occur and is usually unaware that one has occurred unless it is more than a few seconds long. In fact, generalized absence seizures are most often only a few seconds long. Ethosuximide is the drug of choice, but it may cause gastrointestinal distress. Divalproex sodium is effective in many of the children who cannot tolerate ethosuximide or who are not well controlled on that antiepileptic. If the absence seizures are associated with generalized tonic-clonic seizures, divalproex sodium is a better choice. Some antiepileptic drugs, such as the sodium channel blockers phenytoin and carbamazepine, can actually worsen generalized from onset seizures.