JME AED Selection in Women — RACP Adult Medicine MCQ

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ModerateNeurologyJME AED Selection in WomenRACP Adult Medicine

A 22-year-old woman with newly diagnosed juvenile myoclonic epilepsy (JME — myoclonic jerks on waking, generalised tonic-clonic seizures, absence seizures) requires an antiepileptic drug. She is on the oral contraceptive pill and planning pregnancy in the future. What is the most appropriate first-line AED?

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Correct answer: A — Levetiracetam

JME is a genetic generalised epilepsy. Sodium valproate is the most effective AED for JME but is CONTRAINDICATED in women of childbearing potential (Pregnancy Prevention Programme — highest teratogenicity risk, 10% major malformations, 30-40% neurodevelopmental disorders). Levetiracetam is the preferred first-line alternative for women. It does not interact with OCP, has low teratogenicity, and is effective for all seizure types in JME. Carbamazepine and phenytoin can WORSEN generalised epilepsies.

Reference: eTG Neurology – 2024 – Epilepsy; ILAE 2024; TGA Valproate Pregnancy Prevention