15th August 2024

You review a 29-year-old woman in the seizure clinic. She has previously attended the first seizure clinic

You review a 29-year-old woman in the seizure clinic. She has previously attended the first seizure clinic and had a workup including an EEG and MRI, having been referred from the Emergency Department.

Her initial presentation was following concerns from colleagues that she would spontaneously stop talking mid-sentence, become unresponsive, and stare ahead for approximately 45 seconds. She would then become responsive but appear confused for several minutes. These episodes happened at least 4 times prior to initial referral.

During EEG, sharp epileptiform discharges were noted over the left temporal lobe during an episode. Examination also revealed left hand fidgeting during this time. MRI showed left hippocampal sclerosis.

She wishes to start anti-seizure therapy, as these episodes are becoming disruptive.

Which is the single most appropriate initial monotherapy?

Select the SINGLE most appropriate option from the list below. Select ONE option only.