Juvenile Myoclonic Epilepsy — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersJuvenile Myoclonic EpilepsySCE Neurology

A 22-year-old woman presents with brief jerks of both arms on waking, without loss of awareness. She also reports occasional generalised tonic-clonic seizures on sleep deprivation. EEG shows generalised 4–6 Hz polyspike and wave discharges. Which antiseizure medication should be avoided?

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Correct answer: B — Carbamazepine

This presentation is consistent with juvenile myoclonic epilepsy (JME). NICE NG217 warns that carbamazepine may exacerbate seizures in people with absence or myoclonic seizures, including JME. Carbamazepine, along with phenytoin, gabapentin, pregabalin, tiagabine and vigabatrin, may worsen generalised seizures. A: Levetiracetam is effective in JME. B: Valproate is effective but restricted in women of childbearing potential. D: Lamotrigine can occasionally worsen myoclonus but is not as contraindicated as carbamazepine. E: Topiramate is used in JME though its use in women of childbearing potential requires a Pregnancy Prevention Programme per MHRA 2024 guidance.

Reference: NICE NG217 (2025)