A 25-year-old woman has two unprovoked generalised tonic-clonic seizures 6 months apart. MRI brain is normal. EEG shows 3 Hz spike-and-wave discharge. Which antiepileptic drug is FIRST-LINE for juvenile absence epilepsy / generalised epilepsy with this EEG pattern?
- A Carbamazepine
- B Phenytoin
- C Valproate sodium ✓
- D Gabapentin
Correct answer: C. Valproate sodium
Explanation
Sodium valproate is first-line for idiopathic generalised epilepsies including juvenile absence epilepsy, juvenile myoclonic epilepsy, and generalised tonic-clonic seizures, as demonstrated in multiple trials including the SANAD trial (arm B). Carbamazepine and phenytoin can paradoxically worsen absence and myoclonic seizures. Gabapentin has limited efficacy in generalised epilepsy. In women of childbearing potential, valproate's teratogenicity must be weighed and levetiracetam/lamotrigine considered.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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