CLINICAL, NEUROPSYCHOLOGICAL AND NEUROPHYSIOLOGICAL CORRELATES OF DRUG RESISTANT JUVENILE MYOCLONIC EPILEPSY
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2015, Vol 2, Issue 36
Abstract
This study was designed to find the clinical, neuropsychologic, EEG and TMS (Transcranial Magnetic Stimulation) characteristics of patients with treatment resistant Juvenile Myoclonic Epilepsy (JME). JME diagnosis was according to the criteria defined by Classification and Terminology Commission of the International League Against Epilepsy. For the purpose of this study, ‘treatment resistance’ was defined as having two or more generalized tonic-clonic seizures (GTCS) or disabling myoclonus resulting in falls, while on optimal dose of a first-line anti-epileptic drug for JME, with proper compliance. All the patients with JME presenting during the study period underwent detailed clinical and EEG evaluation. Hospital Anxiety and Depression score (HADS) was used to screen for anxiety and depression. Single and paired pulse (TMS) parameters were used to measure cortical excitability. We identified 190 patients with JME during the study period, of which 30 (15.8%) were diagnosed as having treatment resistance JME. Patients with drug resistant JME were found to have statistically significant markers in the form of - later age of onset of myoclonic jerks, absence of typical early morning myoclonia, higher scores for depression and anxiety, low IQ scores and persistent EEG abnormalities while on treatment. Frequency of GTCS showed inverse correlation with IQ scores and direct correlation to the anxiety/depression scores. These patients also had paradoxically decreased cortical excitability, probably related to the high antiepileptic drug doses they were taking. We conclude that treatment resistance in JME is not very rare and that such patients form a distinct subtype with certain atypical clinical and electrophysiological characteristics, with a higher risk of developing anxiety and depression
Authors and Affiliations
Davis Manuel, Rathore C. B. , Alie Alexander
Keywords
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- EP ID EP232930
- DOI 10.18410/jebmh/2015/780
- Views 79
- Downloads 0
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