New Onset Primary Generalized Epilepsy in Adolescence

A 15-year-old girl has been having difficulties with clumsiness and dropping objects. These episodes have started in the past year, and are increasing in frequency and intensity. They occur more commonly in the early hours of the morning. Last week after she dropped and broke her glass of orange juice following a sudden involuntary jerk of her hand, she finally decided it is time to see her doctor who subsequently referred her to you for neurology consult. On further questioning, she does have a cousin with epilepsy and when in elementary school was noted by teachers to have episodes of daydreaming. She is a good student receiving As and Bs in most of her subjects in high school. Her neurologic exam is normal. Her EEG shows generalized 4 Hz spike-and-wave discharges as well as a few fragments of spikes in the frontotemporal areas bilaterally. What is your decision pathway in terms of diagnostic and treatment approaches for her?