Which is a first-line medication for generalized tonic-clonic seizures?

Topiramate is considered a first-line medication for generalized tonic-clonic seizures due to its effectiveness in controlling seizures in various forms, including both partial and generalized seizures. This drug works by enhancing the activity of GABA, an inhibitory neurotransmitter, and by blocking certain voltage-gated sodium channels, which helps to stabilize neuronal membranes and reduce excitability in the brain. Its broad spectrum of action makes it a suitable choice for individuals with generalized tonic-clonic seizures, as it helps in minimizing seizure frequency and severity.

While other medications, such as ethosuximide, felbamate, and vigabatrin, have their own specific uses within the realm of epilepsy treatment, they are not classified as first-line agents for generalized tonic-clonic seizures. Ethosuximide, for example, is primarily effective for absence seizures, whereas felbamate is often reserved for refractory cases due to its potential for serious side effects. Vigabatrin is typically used for infantile spasms and refractory complex partial seizures, making it less relevant for the generalized tonic-clonic seizure indication. Therefore, topiramate is the most appropriate first-line treatment among the options provided.