A 22-year-old woman with generalised epilepsy (myoclonic jerks, absence, and occasional tonic-clonic seizures) starting at age 14 is MOST likely to have which epilepsy syndrome, and what is the MOST appropriate first-line drug?
- A Childhood absence epilepsy; ethosuximide
- B Lennox-Gastaut syndrome; clobazam
- C Juvenile myoclonic epilepsy (JME); valproate ✓
- D Dravet syndrome; stiripentol
Explanation
Juvenile myoclonic epilepsy (JME) classically presents in adolescence (14-18 years) with morning myoclonic jerks, absence seizures, and generalised tonic-clonic seizures (often triggered by sleep deprivation). Sodium valproate is the most effective first-line agent (seizure freedom ~80%) for JME as it addresses all three seizure types. JME is lifelong and typically not remitting; patients often require lifelong therapy. Valproate must be avoided in women of childbearing age (teratogenicity); levetiracetam or lamotrigine are alternatives. Childhood absence epilepsy remits by adulthood; Lennox-Gastaut and Dravet syndrome have developmental delay.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.