An 18-year-old man reports jerks of both arms within an hour of waking, present for 2 years, and two early-morning generalized tonic-clonic seizures after sleep deprivation. Examination and MRI are normal. The most characteristic EEG finding and first-line drug are:

• A 3 Hz spike-and-wave, ethosuximide
• B Temporal sharp waves, carbamazepine
• C 4 to 6 Hz polyspike-and-wave, valproate ✓
• D Hypsarrhythmia, ACTH

Explanation

Morning myoclonus plus generalized tonic-clonic seizures in an adolescent is classic juvenile myoclonic epilepsy, showing 4 to 6 Hz polyspike-and-wave discharges, often photosensitive. Valproate is first line in males. Ethosuximide treats absence only, 3 Hz spike-and-wave belongs to absence epilepsy, and hypsarrhythmia with ACTH defines West syndrome. Carbamazepine can worsen generalized epilepsies.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.