Abstracts

Rationale: As one of the most common epilepsy syndrome seen in adolescents and adults, juvenile myoclonic epilepsy(JME) is known to respond well to antiepileptic medications(AED) and usually have a good prognosis, but some cases turn up with intractable seizures. Through a retrospective analysis of a JME patients diagnosed and treated at a tertiary hospital, we have examined the details of their clinical course with emphasis on their pharmaceutical treatment and details of varying prognosis. Methods: A total of 146 patients were diagnosed with JME at Severance Children s Hospital, a tertiary clinical center from year 1994 to year 2012, and as 22 patients were excluded due to short follow up period, medical charts of 124 patients were reviewed.Results: With a gender ratio of male and female of 1.0 to 1.14, the patients were first diagnosed with JME at the average age of 11.79 years, ranging from 7.2 to 19.7 years, but 23.39% of the patients (n=29) had shown their first afebrile seizures before the age of 10. The clinical course of JME in these patients was favorable with 83.87% (104/124) with seizure freedom after an average of 40.8 months follow up period. As three patients were only observed with no medications, only 3.31% (4/121) were able to completely discontinue their medications, but 34.71% were able to control their seizures at their first tried AED. Seizure control rate rises up to 45.45% for those with controlled seizures with only one AED at most recent follow up visit, when 13 more patients are included. As 1st choice of AED, lamotrigine was used most, while levetiracetam was considered most for 2nd or 3rd chance at alternative or adjuvant AED. Levetiracetam was used most as the final AED for those with only one medication, followed by lamotrigine and valproate in order.Conclusions: With the emergence of new AEDs, levetiracetam and lamotrigine has replaced the old classical drugs, as first choice for JME patients with stable control of seizures over sufficient period of time. A prospective randomized study may give us more insight into the accurate efficacy and indication for these medications.