Juvenile myoclonic epilepsy — SCE Neurology MCQ

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HardEpilepsyJuvenile myoclonic epilepsySCE Neurology

An 18-year-old with juvenile myoclonic epilepsy has good control of generalised tonic–clonic seizures on levetiracetam, but morning myoclonus becomes substantially more frequent after another antiseizure medicine is added. Which newly added drug is specifically recognised as occasionally exacerbating myoclonic seizures?

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Correct answer: E — Lamotrigine

NICE warns that lamotrigine can occasionally exacerbate myoclonic seizures. The temporal worsening after its addition is therefore clinically meaningful even though lamotrigine is useful for other seizure types. Levetiracetam and sodium valproate are first-line options for myoclonic seizures, subject to current valproate restrictions; clonazepam and piracetam are among specialist second-line possibilities rather than recognised causes of this pattern. The newly introduced lamotrigine should be reviewed with the epilepsy team rather than stopped unsupervised.

Reference: NICE NG217: Treating epileptic seizures. https://www.nice.org.uk/guidance/ng217/chapter/5-Treating-epileptic-seizures-in-children-young-people-and-adults