A 16-year-old boy reports brief lightning-like jerks of both arms on waking, occasionally dropping his toothbrush. He has had two generalised tonic-clonic seizures, both shortly after awakening. EEG shows generalised 4 to 6 Hz polyspike-and-wave discharges. What is the drug of choice?
- A Carbamazepine
- B Sodium valproate ✓
- C Phenytoin
- D Gabapentin
Correct answer: B. Sodium valproate
Explanation
The morning myoclonic jerks, awakening grand mal seizures, and 4 to 6 Hz polyspike discharges establish juvenile myoclonic epilepsy. Sodium valproate controls all three seizure types and is the classical drug of choice, though levetiracetam or lamotrigine is preferred in women of childbearing age because of valproate teratogenicity. Carbamazepine, phenytoin, and gabapentin are sodium-channel or other agents effective in focal seizures but can aggravate myoclonus and generalised spike-wave discharges.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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Written and medically reviewed by the StethoPrep medical team.