Diagnostic and therapeutic approach to drug-resistant juvenile myoclonic epilepsy.

Abstract

INTRODUCTION:

Juvenile myoclonic epilepsy (JME), also known as Janz syndrome, is a common form of generalized epilepsy of presumed genetic origin representing up to 10% of all epilepsy cases. Despite adequate anti-seizure medication (ASM) treatment, seizures persist in one-third of JME patients.

AREAS COVERED:

A literature search was conducted using Pubmed search on the topics of drug-resistant JME.

EXPERT OPINION:

About 30% of JME patients are drug-resistant. Valproate (VPA) is considered the first-choice drug. In women of childbearing potential, levetiracetam (LEV) should represent the first-choice treatment. Alternative monotherapy or add-on therapy should be considered in subjects with resistant seizures after the exclusion of pseudo-drug resistance. The choice of the add-on ASM depends on the predominant seizure type. In subjects with persistent bilateral tonic-clonic seizures, LEV or lamotrigine should be firstly considered. In patients with difficult-to-treat myoclonic seizures, clonazepam or LEV are recommended. In case of persistent absences, ethosuximide should be considered. With appropriate selection and safeguards in place, VPA should remain available as an option in women of childbearing potential whose seizures are resistant to other treatments.

• Authors: Michele Ascoli, Giovanni Mastroianni, Sara Gasparini, Pasquale Striano, Vittoria Cianci, Sabrina Neri, Valentina Bova, Anna Mammì, Antonio Gambardella, Angelo Labate, Umberto Aguglia, Edoardo Ferlazzo
• Journal: Expert review of neurotherapeutics (Expert Rev Neurother) Vol. 21 Issue 11 Pg. 1265-1273 (11 2021) ISSN: 1744-8360 [Electronic] England
• PMID: 33993822 (Publication Type: Journal Article, Review)

Chemical References

• Anticonvulsants
• Pharmaceutical Preparations
• Levetiracetam
• Valproic Acid

Topics

• Anticonvulsants (therapeutic use)
• Female
• Humans
• Levetiracetam (therapeutic use)
• Myoclonic Epilepsy, Juvenile (diagnosis, drug therapy)
• Pharmaceutical Preparations
• Valproic Acid (therapeutic use)