A 14-year-old girl reports morning jerky movements of both arms soon after waking, present for several months, along with two witnessed generalized tonic-clonic convulsions shortly after awakening. She is otherwise well and her neurological examination is normal. EEG shows 4 to 6 Hz polyspike-and-wave discharges. What is the drug of choice?
- A Sodium valproate ✓
- B Phenytoin
- C Carbamazepine
- D Ethosuximide
Correct answer: A. Sodium valproate
Explanation
Morning myoclonic jerks with generalized tonic-clonic seizures on awakening and 4 to 6 Hz generalized polyspikes in a normal adolescent indicate juvenile myoclonic epilepsy. Sodium valproate controls all three seizure types and is the classic first-line agent. Carbamazepine and phenytoin are sodium channel blockers that can aggravate myoclonus and absences, and ethosuximide treats absence seizures alone without protecting against tonic-clonic seizures.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
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Written and medically reviewed by the StethoPrep medical team.