Abstracts

Rationale: It has been suggested that 80% of patients with Juvenile Myoclonic Epilepsy (JME) reach seizure control when treated with adequate antiepileptic drugs (AED) and avoidance of precipitant factors in daily life. It has also been suggested that the expression of reflex traits such as photosensitivy and praxis induction may compromise the prognosis in this epilepsy syndrome. The present study aimed correlate response to treatment according to reflex traits and the presence of anxiety in patients with JME followed-up for at least three years. Methods: Seventy-six JME patients underwent a Video-EEG Neuropsychological Protocol including tasks such as reading, speaking, writing, spatial construction, written/mental calculation and also eyes opening/closure, hyperventilation (HV), intermittent photic stimulation (IPS) and sleep. A discharge index was obtained according to Matsuoka et al. (2000). Sixty five (35 females) out of 76 (86%) were followed-up for at least three years. All patients received AEDs and were advised to avoid precipitant factors. Two female patients were excluded for getting off medication, without seizure control (adherence problem). Fifty-two patients had psychiatric evaluation through SCID(Schedule Clinical Interview for DSM-IV)I and II. (Matsuoka H, Takahashi T, Sasaki M, Matsumoto K, Yoshida S, Numachi Y, Saito H, Ueno T, Sato M. (2000) Neuropsychological EEG activation in patients with epilepsy. Brain 123:318-330). Results: Ten out 63 (15.9 %) patients had provocative effect induced only by sleep and hyperventilation considered general precipitant factors (GPF); 13 (20.6%) were photosensitive, 10 (15.9%) were sensitive to eye closure, 19 (30.2%) presented praxis induction. At the end of the follow-up, three patients who had none activation in Video-EEG remained seizure free and were out off medication. Sixty patients remained treated with AEDs in monotherapy (35) or in different combinations (25) At the end of the three-year follow-up 44 (69.8%) were seizure free or had rare myoclonic seizures [13 (29.5%) without any kind of activation; 8 (18.1%) presented only sensitivity to GPF; 10 (22.7%) were photosensitive; 7 (15.9%) were sensitive to eyes opening/closure;13 (29.5%) presented praxis induction]. Among 19 (30.1%) patients still having frequent seizures, 7 (36.8%) had no kind of activation; 3 (15.7%) had sensitivity to GPF only; 3 (15.8%) were photosensitive; 5 (26.3%) were sensitive to eyes closure and 6 (31.6%) had praxis induction]. Eight out of 17 (47%) patients without control had anxiety while only 9 out of 35 (25.7%) patients with seizure control had this diagnosis. Conclusions: In our study there was no difference regarding reflex traits between patients with and without seizure control after a three-years of follow-up, although three patients without any type of activation remained seizure free and went off medication. Instead, anxiety was confirmed as a factor of bad prognosis.