A 14-year-old boy reports early-morning jerks of both arms shortly after waking, occasionally followed by a generalized tonic-clonic seizure. Neurological examination and MRI are normal. EEG shows generalized 4 to 6 Hz polyspike-and-wave discharges. First-line drug of choice?
- A Valproate ✓
- B Phenytoin
- C Carbamazepine
- D Ethosuximide
Correct answer: A. Valproate
Explanation
This is juvenile myoclonic epilepsy, an idiopathic generalized epilepsy with morning myoclonus and polyspike discharges. Valproate is the classic first-line agent because it controls all three seizure types seen in JME: myoclonic, absence-like, and tonic-clonic. Ethosuximide treats absence seizures but is ineffective against myoclonic and tonic-clonic seizures. Carbamazepine and phenytoin can worsen generalized myoclonic and absence seizures.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.