A 14-year-old girl reports early morning jerks of both arms shortly after waking, twice causing a fall. She also describes two brief generalized tonic-clonic seizures on sleep deprivation before school examinations. Neurological examination and intelligence are normal. Which drug should be avoided in her treatment?
- A Levetiracetam
- B Carbamazepine ✓
- C Valproate
- D Lamotrigine
Correct answer: B. Carbamazepine
Explanation
The picture is juvenile myoclonic epilepsy: myoclonic jerks on awakening, generalized tonic-clonic seizures, adolescence onset, and precipitation by sleep deprivation. It responds well to valproate, levetiracetam, or lamotrigine. Carbamazepine is a sodium-channel blocker effective in focal epilepsies but can aggravate myoclonus and absence seizures in idiopathic generalized epilepsies, potentially worsening JME into myoclonic status. This aggravation by carbamazepine is the discriminating fact that examiners test.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.