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Pediatric Epilepsy Syndromes 05

Topic: Pediatric

Created on Thursday, October 4 2007 by jdmiles

Last modified on Thursday, October 4 2007.

A 9 year old girl presents to your office accompanied by her parents. The parents state that she has been having frequent staring spells. Past medical history is otherwise unremarkable. There is no family history of seizures. Exam is normal. You obtain an EEG, which shows the following finding:

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Of the following options, which agent is the best choice as a first-line monotherapy treatment?

A) Valproate

B) Phenytoin

C) No treatment is indicated

D) Clonazepam

E) Vigabatrin

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This question was created on October 04, 2007 by jdmiles.
This question was last modified on October 04, 2007.

ANSWERS AND EXPLANATIONS

A) Valproate

This answer is correct.

This child has childhood absence epilepsy. Ethosuximide is considered the initial treatment of choice if the patient has only absence seizures. If motor seizures are also observed, then valproate is the preferred agent. Lamotrigine is also a commonly-used monotherapy. (See References)


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B) Phenytoin

This answer is incorrect.

This child has childhood absence epilepsy. Phenytoin may be ineffective in absence seizures, and is not a recommended first-line agent. (See References)


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C) No treatment is indicated

This answer is incorrect.

This child has childhood absence epilepsy. Untreated, she is likely to continue having frequent absence seizures, and is at risk for generalized tonic-clonic and myoclonic seizures. (See References)


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D) Clonazepam

This answer is incorrect.

This child has childhood absence epilepsy. Clonazepam is frequently used as adjunctive therapy if ethosuximide or valproate fail to control seizures. However, it is not the recommended first-line treatment. (See References)


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E) Vigabatrin

This answer is incorrect.

This child has childhood absence epilepsy. Vigabatrin is contraindicated in this syndrome. Some sources state that vigabatrin may worsen absence seizures. (See References)


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References:

1. Levin, K.H., and Luders, H.O. (Eds.) (2000). Comprehensive Clinical Neurophysiology. W.B. Saunders Company, Philadelphia.
2. Trescher, W.H., and Lesser, R.P. (2004). The epilepsies. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, Fourth Edition. Butterworth Heinemann, Philadelphia, pp. 1953-1992.
3. edited by Richard T. Johnson, John W. Griffin and Justin C. McArthur. . St. Louis, Mo. : Mosby, 2001. (ISBN:0323014720)	Advertising:
4. Wheless, J.W., Clarke, D.F., and Carpenter, D. (2005). "Treatment of pediatric epilepsy: expert opinion, 2005." J Child Neurol, 20 Suppl 1 S1-56; quiz S59-60. (PMID:16615562)
5. Faught, E. (2003). "Clinical trials for treatment of primary generalized epilepsies." Epilepsia, 44 Suppl 7 44-50. (PMID:12919339)
6. Murphy, ., and Delanty, . (2000). "Primary Generalized Epilepsies." Curr Treat Options Neurol, 2(6) 527-542. (PMID:11096777)


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pediatric
Pediatric Epilepsy Syndromes 05
Question ID: 100307151
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 10/04/2007
Modified: 10/04/2007
Estimated Permutations: 25200