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

The first-line treatment for tonic-clonic seizures is sodium valproate. This medication is highly effective in controlling these types of seizures due to its broad-spectrum antiepileptic properties. Sodium valproate works by increasing the availability of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, in the brain, which helps to stabilize the electrical activity that leads to seizures.

In the context of tonic-clonic seizures, which can be more severe and generalized, sodium valproate is often preferred owing to its efficacy and the fact that it is effective for multiple seizure types, including both tonic-clonic and absence seizures. Its use in the first-line treatment is well-supported by clinical guidelines, reflecting its importance in ensuring better management and control of seizure episodes.

Other options listed, while useful in treating various forms of epilepsy, do not serve as first-line treatments specifically for tonic-clonic seizures. For instance, lamotrigine is more commonly used in partial seizures and certain generalized seizures but is not the primary option for tonic-clonic seizures. Ethosuximide is primarily indicated for absence seizures. Clozapine, on the other hand, is an antipsychotic medication and not indicated for seizure management. This distinction underscores