A 22-year-old man presents with early-morning myoclonic jerks involving the arms, generalized tonic-clonic seizures on awakening, and absence seizures. EEG shows 4-6 Hz polyspike-and-wave discharges. Which is the most appropriate long-term treatment?
- A Carbamazepine
- B Levetiracetam monotherapy
- C Valproate ✓
- D Phenytoin
Correct answer: C. Valproate
Explanation
This is juvenile myoclonic epilepsy (JME), a genetic generalized epilepsy with the classic triad of myoclonic jerks, GTCS, and absences, typically with 4-6 Hz polyspike-wave on EEG. Valproate is the most effective drug for JME and achieves complete control in about 80%. Carbamazepine and phenytoin can worsen myoclonic and absence seizures in genetic generalized epilepsies. Levetiracetam is a reasonable alternative, particularly in women of childbearing age due to valproate teratogenicity, but valproate remains the gold standard for efficacy per standard epilepsy texts.
Reference: Bradley's Neurology in Clinical Practice, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.