Do carbamazepine and phenytoin aggravate juvenile myoclonic epilepsy?

Genton, Pierre; Gélisse, Philippe; Thomas, Pierre; Dravet, Charlotte

doi:10.1212/wnl.55.8.1106

Cited by 177 publications

(124 citation statements)

References 27 publications

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“…It is very important to choose an appropriate AED treatment in this case because treatment with carbamazepine or oxcarbazepine may have an aggravating effect 10,19,20 in IGE. Morever, in our study, the presence of asymmetric features in JME was not associated with a poor response to a judicious anti-epileptic treatment including more recent AEDs.…”

Section: Discussionmentioning

confidence: 99%

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Epileptiform Asymetries and Treatment Response in Juvenile Myoclonic Epilepsy

Létourneau

Cieuta‐Walti

Deacon

2010

Can. j. neurol. sci.

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Juvenile myoclonic epilepsy (JME) is a common idiopathic generalized and age-related epileptic syndrome. This syndrome is distinctively characterized by myoclonic jerks often associated with generalized tonic-clonic seizures (GTCS) and, less often, absence seizures 1,2 . Myoclonic seizures occur often shortly after awakening and can be precipitated by sleep deprivation and also by alcohol and photic stimulation. Usually, patients with JME respond well to appropriate treatment with valproate 3,4 . Other useful anti-epileptic drugs (AEDs) also used with other generalized epilepsies include: lamotrigine, levetiracetam and topiramate 5 .The interictal electroencephalogram (EEG) shows diffuse bilateral polyspike and slow waves (PSW) and spike and wave complexes (SWC) on a normal background 2 . The usual ABSTRACT: Background: Epileptiform electroencephalogram (EEG) asymmetries are not uncommon in juvenile myoclonic epilepsy (JME) and can contribute to the misdiagnosis of this syndrome. The objective of this study is to further characterize patients with focal or asymmetric epileptiform electroencephalographic abnormalities and more specifically in terms of response to treatment. Controversial data exists in the literature concerning this issue. Methods: We retrospectively reviewed clinical and EEG data of a group of consecutive JME patients followed at our Epilepsy Service. The first EEG available for each patient was reviewed blindly by two independent electroencephalographers. Results: Twenty-eight patients with JME were identified: 11 (39.3%) were resistant to at least one appropriate anti-epileptic drug (AED), including valproate, lamotrigine, topiramate or levetiracetam. All patients except two had generalized epileptiform abnormalities. Overall, EEG asymmetries were detected in 57.1% of the cases. The proportion of EEG asymmetries between AED-sensitive group (52.9%) and AED-resistant group (63.5%) did not reach statistical significance. Concordance between examiners for identification of EEG asymmetries was good. Analysis of patients with and without asymmetries showed no statistically significant differences in comparisons of age, family history of seizure, presence of polyspike and slow wave, photosensitivity and timing of EEG related to the onset of treatment. Conclusion: Asymmetric electroencephalographic abnormalities are frequent in patients with JME. These features should not be misinterpreted as being indicative of partial epilepsy. In our group, asymmetries were not associated with resistance to treatment.RÉSUMÉ: Asymétries épileptiformes et réponse au traitement dans l'épilepsie myoclonique juvénile. Contexte : Les asymétries épileptiformes à l'EEG sont fréquentes dans l'épilepsie myoclonique juvénile (EMJ) et peuvent contribuer à un diagnostic erroné de ce syndrome. Le but de cette étude était de mieux caractériser les patients qui ont des anomalies focales ou des anomalies asymétriques épileptiformes à l'EEG, plus particulièrement en ce qui concerne la réponse au traitement. Il existe dans la littéra...

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Section: Discussionmentioning

confidence: 99%

“…The usual myoclonus 10,11 . We would like to determine whether there is a difference in response to treatment between patients with and without EEG asymmetries.…”

mentioning

confidence: 99%

Epileptiform Asymetries and Treatment Response in Juvenile Myoclonic Epilepsy

Létourneau

Cieuta‐Walti

Deacon

2010

Can. j. neurol. sci.

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“…Carbamazepine is a first-line treatment for partial-onset and primary generalized tonic-clonic seizures, but is ineffective against, and may exacerbate, absence and myoclonic seizures. 8 To minimize CNS-related side effects, CBZ should be initiated at 100 -200 mg daily and increased by 100 -200 mg increments every 3-14 days as needed for seizure control, typically over one to two months. The final dose in part depends on the extent of autoinduction; i.e., the degree to which CBZ induces its own metabolism.…”

Section: Older Generation Aeds Carbamazepinementioning

confidence: 99%

Currently Available Antiepileptic Drugs

Schachter

2007

Neurotherapeutics

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Summary:Many new antiepileptic drugs (AEDs) have become available over the past 15 years. At the same time, the emphasis on treating patients with epilepsy has grown from stopping seizures to avoiding side effects and maximizing quality of life. This review summarizes currently available AEDs, and presents general treatment principles and guidelines for AED selection. Unfortunately, despite the increased treatment options of today, seizure freedom without side effects remains unattainable for too many patients with epilepsy. Consequently, there remains a significant need for further development of new therapies.

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“…Therefore the diagnosis of partial epilepsy will be premature if it is based on a single focal interictal abnormality and isolated clinical signs. This could result in the wrong treatment and aggravation of seizures 30 . Serial EEGs and with sleep deprivation, photic stimulation and hyperventilation could be helpful in revealing the typical generalized discharges.…”

mentioning

confidence: 99%