A 14-year-old boy reports jerky movements of both arms within an hour of waking, occurring almost daily, and one witnessed generalized tonic-clonic seizure after a night of sleep deprivation. Neurological examination and MRI are normal. EEG shows generalized 4 to 5 Hz polyspike-and-wave discharges. The best initial drug is:
- A Valproate ✓
- B Phenytoin
- C Ethosuximide
- D Carbamazepine
Correct answer: A. Valproate
Explanation
Early morning bilateral myoclonic jerks plus sleep-deprivation triggered GTCS in an adolescent with normal cognition and 4 to 5 Hz polyspikes is juvenile myoclonic epilepsy. Valproate controls both the myoclonic and generalized tonic-clonic components and is first line, though in females its teratogenicity shifts practice toward levetiracetam. Carbamazepine and phenytoin can worsen myoclonus, and ethosuximide treats absence seizures only, not myoclonic or tonic-clonic seizures.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.