A 10-year-old child is evaluated in seizure clinic for therapy of absence seizures. Which of the following drugs would be most useful in this patient’s condition with the lowest risk of hepatic toxicity?
(E) valproic acid
(A) Ethosuximide is an older antiseizure drug that is very useful in absence but not tonic-clonic seizures. It is usually safe, having sedation as its major adverse effect. Gabapentin (choice B) is useful in some cases of partial seizures but not absence seizures. It does, however, appear to have significant usefulness against neuropathic pain and postherpetic neuralgia. Lithium (choice C)is the usual drug of choice in bipolar disorder (valproic acid and carbamazepine are also used), but is of no value in epilepsy. Phenytoin (choice D) is a drug of choice (with carbamazepine) in partial (tonic-clonic) seizures but has no demonstrated efficacy in absence seizures. Valproic acid (choide E) has unusual versatility. It is effective in both absence and tonic-clonic seizures and in the management of bipolar disorder as well. Unfortunately, it carries significant risk of hepatotoxicity.