Newly Diagnosed Generalised Epilepsy in a Woman of Childbearing Potential

Patient B-217, a 24-year-old woman, is referred to the neurology clinic after a generalised tonic-clonic seizure witnessed by her partner. She has no previous history of seizures, head injury, or febrile convulsions. She is a full-time university student, does not smoke, and drinks alcohol occasionally (about 5 units per week). She takes no regular medications and has no known drug allergies. She is not currently pregnant and is not using any form of contraception. General and neurological examinations are normal. Blood tests: serum creatinine 0.9 mg/dL, eGFR 95 mL/min/1.73 m², liver function tests within normal limits. Electroencephalogram shows generalised spike-wave discharges. Magnetic resonance imaging of the brain is normal. A diagnosis of newly diagnosed generalised epilepsy is made. Prescribe the initial antiepileptic medication for this patient, including the starting dose and titration schedule up to the maintenance dose. Consider her childbearing potential and the need for a pregnancy prevention programme.