Myoclonic Seizures

Key points

• Myoclonic seizures (NICE NG217, 2022 updated January 2025): sodium valproate first-line, but LEVETIRACETAM for women and girls of childbearing potential · be aware LAMOTRIGINE may EXACERBATE myoclonic seizures.
• Focal seizures — the older 'carbamazepine first-line' teaching is SUPERSEDED. NG217: CONSIDER LAMOTRIGINE or LEVETIRACETAM as first-line monotherapy; if the first is unsuccessful, consider the other.
• Focal add-on options if monotherapy fails: carbamazepine, lacosamide or lamotrigine · the January 2025 safety update REMOVED sodium valproate from the first-line add-on list for focal seizures.
• *carbamazepine may exacerbate absence seizures **carbamazepine may exacerbate myoclonic seizures — do not use carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin where absence or myoclonic seizures are present or juvenile myoclonic epilepsy is suspected.