A 6-year-old boy is brought to the office by his mother due to difficulty with his behavior in school. She says that his teacher is concerned that he does not pay attention in class and his grades are dropping to the point he may need medication to help him focus. The patient's mother has noticed that at home he seems to stare into space for several seconds, multiple times throughout the day. This occurs even when he is watching his favorite television show, and he seems to ignore her when she calls his name. The patient has no previous medical problems and takes no medications. He has an older brother with attention-deficit hyperactivity disorder and an aunt with epilepsy. Which of the following is the most appropriate pharmacotherapy for this patient?

Question

A 6-year-old boy is brought to the office by his mother due to difficulty with his behavior in school.  She says that his teacher is concerned that he does not pay attention in class and his grades are dropping to the point he may need medication to help him focus.  The patient's mother has noticed that at home he seems to stare into space for several seconds, multiple times throughout the day.  This occurs even when he is watching his favorite television show, and he seems to ignore her when she calls his name.  The patient has no previous medical problems and takes no medications.  He has an older brother with attention-deficit hyperactivity disorder and an aunt with epilepsy.  Which of the following is the most appropriate pharmacotherapy for this patient?

Quizplus · Accepted Answer

11ec160b_3c1a_23bd_9249_7bd59ba7e9b6_MD0001_00 Absence seizures, a type of generalized epilepsy, present in children age 4-10 as brief staring spells with a momentary lapse in consciousness. Automatisms, such as rhythmic blinking or repetitive lip smacking, may occur. Most absence seizures last approximately 10 seconds, and behavior and awareness typically return immediately to normal following an attack. The patient experiences no postictal period and usually has no recollection that a seizure has occurred. Absence seizures are characteristically provoked by hyperventilation, and electroencephalogram will show generalized 3-Hz spike-wave complexes. Treatment of absence seizures is typically with ethosuximide, which inhibits T-type calcium channels in thalamic neurons. Valproate can also be used if first-line therapy is not tolerated or ineffective. Childhood absence epilepsy is typically benign, and seizures often resolve before puberty. (Choices A and E) Narrow-spectrum anticonvulsants (eg, carbamazepine, gabapentin, phenobarbital, phenytoin) are generally favored for focal-onset seizures. Carbamazepine can worsen absence seizures and phenobarbital is ineffective in these patients. (Choice C) Lorazepam is a benzodiazepine that is used as a first-line anticonvulsant in a patient with status epilepticus. (Choice D) Methylphenidate is an indirect-acting sympathomimetic used to treat attention-deficit hyperactivity disorder (ADHD). Although ADHD may present similarly with "inattention," staring episodes consistent with absence seizures do not occur out of boredom or lack of focus and cannot be interrupted by verbal/tactile stimuli. Educational objective: Absence seizures are a type of generalized epilepsy characterized by brief staring spells with momentary loss of awareness followed by an abrupt return to full consciousness. A classic 3-Hz spike-wave is seen on electroencephalogram; the treatment is ethosuximide. __________ References: Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/28195639)

A 6-Year-Old Boy Is Brought to the Office by His