Prescribing Safety Assessment (PSA) Practice Exam

What is the first-line treatment for generalised tonic-clonic seizures in men?

1. Ethosuximide

2. Carbamazepine

3. Valproate

4. Levetiracetam

The correct answer is: Valproate

Valproate is considered the first-line treatment for generalised tonic-clonic seizures in adults, including men. This anticonvulsant drug is known for its broad-spectrum efficacy against various kinds of seizures, particularly generalized seizures, which include tonic-clonic episodes. Valproate works by increasing the availability of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, thereby stabilizing the neuron membranes and reducing excessive neuronal firing. This effectiveness is backed by numerous clinical guidelines and studies that support valproate's use as a cornerstone in the management of generalized seizures. It is also chosen because of its ability to manage both the tonic-clonic seizures and other types of seizures, making it a versatile option for patients who may have mixed seizure types. The other medications listed are effective in certain contexts but are not the first-line choice for generalized tonic-clonic seizures. Ethosuximide is primarily indicated for absence seizures, carbamazepine is often used for focal seizures and may exacerbate generalized tonic-clonic seizures in some patients, and levetiracetam, while also effective, is not categorized as the first-line treatment for this specific seizure type.