A 15-year-old boy reports jerky movements of both arms within an hour of waking, occasionally spilling his breakfast, plus two early-morning generalized tonic-clonic seizures after late nights. Neurological examination is normal. EEG shows generalized 4 to 6 Hz polyspike-and-wave discharges. The best first-line drug is:
- A Valproate ✓
- B Phenytoin
- C Carbamazepine
- D Gabapentin
Correct answer: A. Valproate
Explanation
The history of morning myoclonic jerks with sleep-deprivation-triggered tonic-clonic seizures and generalized fast polyspike-wave EEG defines juvenile myoclonic epilepsy. Valproate controls the myoclonic, generalized tonic-clonic, and any absence components and is the conventional first-line choice in Indian practice; levetiracetam is a reasonable alternative, particularly in girls of childbearing potential. Carbamazepine and phenytoin are sodium-channel blockers that can exacerbate myoclonus and absence seizures in this syndrome.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.