Juvenile Myoclonic Epilepsy (JME)

 

Presentation

Common epilepsy especially in girls, with onset between 10 – 20 years age.

Presence of multiple seizure types including frequent myoclonic jerks (always present), GTCs and absences.

 

Myoclonic jerks are predominant seizures and often noticed in mornings or evenings when tired. Enquire about sudden random jerking of limbs while writing or eating that leads to dropping a pen or cutlery.

 

GTCs are frequently seen, often when sleep deprived. Many also have absences.

 

Investigation

Detailed history and video evidence helps in making diagnosis.

EEG shows 3 to 6 Hz generalised polyspike and slow wave discharges, especially when tired or sleep-deprived. Photosensitivity is frequently seen.

 

Management

Seizures respond best to Valproate, but this should be avoided in girls of childbearing age.

 

Other helpful medications include Levetiracetam, Lamotrigine, Clobazam or Topiramate. Seizures may be difficult, take input from tertiary neurology for optimal combination of AEDs to control different seizure types.

 

Seizures precipitated by sleep deprivation, stress, alcohol or flashing lights.

Lifelong type of epilepsy, so medications should not be withdrawn as seizures would likely return.