Prescribing Safety Assessment (PSA) Practice Exam

In women experiencing myoclonic seizures, which antiepileptic drug is considered first-line?

1. Levetiracetam

2. Valproate

3. Carbamazepine

4. Phenytoin

The correct answer is: Levetiracetam

Levetiracetam is considered the first-line therapy for myoclonic seizures in women. This is due to its favorable pharmacokinetic profile, which includes rapid clearance and a lower potential for drug interactions compared to other antiepileptic medications. Levetiracetam has a mechanism of action that is well-suited for addressing myoclonic seizures, as it modulates synaptic neurotransmitter release and has a broad spectrum of efficacy against a variety of seizure types. In addition, its tolerability and side effect profile make it a preferable choice, particularly in populations where long-term management is needed. While other medications like valproate also show efficacy for myoclonic seizures, they come with additional considerations such as teratogenicity and potential weight gain, which may be particularly concerning for women of childbearing age. Carbamazepine and phenytoin are generally not first-line treatments for myoclonic seizures since they are more commonly used for focal seizures and can exacerbate myoclonic seizure types. This further underscores why levetiracetam is the most suitable first-line option in this context.