Focal clinical and electroencephalographic features in patients with juvenile myoclonic epilepsy

Jayalakshmi, Sita; Rao, B. Srinivasa; Sailaja, S.

doi:10.1111/j.1600-0404.2009.01270.x

Cited by 41 publications

(51 citation statements)

References 30 publications

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“…In other studies also noncompliance with AEDs has been an important factor contributing to lack of seizure control [8]. Various studies have found comorbid psychiatric or personality disorders in patients with JME and this has been suggested to be one of the reasons for noncompliance of AEDs [9, 13, 16]. Approximately half of our patients were not aware of the important lifestyle modifications required for JME, mainly taking adequate sleep and avoiding sleep deprivation, leading to breakthrough seizures.…”

Section: Discussionmentioning

confidence: 81%

“…Focal clinical and EEG abnormalities are not uncommon in JME as found in a study from India and this can be a major reason for misdiagnosis in JME [13]. If the treating physician is not well-experienced in epilepsy care and not aware of the fact that focal findings can occur in JME, such abnormalities would often lead to misdiagnosis of focal epilepsy, leading to use of carbamazepine or oxcarbazepine, which would not be effective in JME, leading to lack of control of seizures [13, 14]. A sleep deprived EEG definitely increases the sensitivity of EEG records, but in private clinical practice patients often undergo the tests immediately after the outpatient consultation and are not called for sleep deprived EEG on another day.…”

Section: Discussionmentioning

confidence: 99%

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Juvenile Myoclonic Epilepsy in Rural Western India: Not Yet a Benign Syndrome

Desai

Jani

2016

Epilepsy Research and Treatment

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Purpose. To study prevalence of uncontrolled seizures in patients with juvenile myoclonic epilepsy [JME] and assess factors responsible for it. Methods. An ambispective study of all patients with JME attending our epilepsy clinic was done. We recruited all patients with JME evaluated between 1 January 2009 and 31 December 2013 and followed them up to 31 December 2015. Results. Amongst 876 patients with epilepsy, JME was present in 73 patients. Amongst them, 53 [72.6%] had uncontrolled seizures prior to neurology consultation. Factors responsible for uncontrolled seizures included pitfalls in diagnosis like absence of prior neurology consultation missed history of myoclonus in prior consults and pitfalls in interpretation of EEG. Pitfalls in management were incorrect antiepileptic drug use, underdosing of AED, noncompliance with lifestyle, noncompliance with medicines, associated psychogenic nonepileptiform events, patients deliberately missing medicines for secondary gain, and concomitant alternative medicine use. 45 (84.9%) patients had “pseudorefractoriness.” True refractoriness [seizures despite 2 correctly dosed rational drugs] was seen in 8 (15.1%) patients only. Conclusion. Three-fourth of our patients had uncontrolled seizures initially, predominantly due to pitfalls in its diagnosis and management. Improving patient awareness and primary physician training for JME management is the need of the hour.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Juvenile Myoclonic Epilepsy in Rural Western India: Not Yet a Benign Syndrome

Desai

Jani

2016

Epilepsy Research and Treatment

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“…The epileptiform activity in JME is typically generalized 4–6 Hz spike‐wave (SW) activity (Pedersen & Petersen, 1998). However, one third of patients with JME may have subtle focal electroencephalography (EEG) abnormalities, sometimes associated with focal semiologic features (Usui et al., 2005; Jayalakshmi et al., 2010).…”

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confidence: 99%

Widespread cortical morphologic changes in juvenile myoclonic epilepsy: Evidence from structural MRI

et al. 2012

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SUMMARYPurpose: Atypical morphology of the surface of the cerebral cortex may be related to abnormal cortical folding (gyrification) and therefore may indicate underlying malformations of cortical development (MCDs). Using magnetic resonance imaging (MRI)-based analysis, we examined cortical morphology in patients with juvenile myoclonic epilepsy (JME). Methods: MRI data was collected for 24 patients with JME and 40 demographically matched healthy controls. FreeSurfer, an automated cortical surface reconstruction method, was applied to compare cortical morphology between patients and controls. Areas of anomalous cortical morphology were defined as regions of interest (ROIs) to contrast regional cortical parameters, such as surface area, average thickness, and mean curvature between patients and controls.Key Findings: In patients with JME, changes to cortical morphology were detected in several regions. In the left hemisphere, these were in insular and cingulate cortices, occipital pole, and middle temporal and fusiform gyri. In the right hemisphere, changes were detected in insular cortex, inferior temporal gyrus, and precuneus. Further analysis of ROIs revealed that these changes are related to differences in surface area rather than average cortical thickness. In addition, mean curvature abnormalities were detected in the insula bilaterally, the left cingulate cortex, and right inferior temporal gyrus. Significance: The morphologic findings in this study suggest that structural abnormalities in JME extend beyond mesial frontal lobe regions of the brain. These may be indicative of areas of subtle cortical folding abnormality related to early disruption of cortical development.

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“…These findings tend to be intermittent and shifting in laterality. 15,[23][24][25] Densearray EEG analysis of patients with absence epilepsy demonstrated ictal onsets, often unilateral, arising from the dorsolateral frontal or orbital frontal lobe followed by stereotyped evolution to involve both mesial frontal and orbital frontal structures. 26 Auras and other "focal" features in patients with GE can lead to the misdiagnosis of FE.…”

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confidence: 99%

Auras in generalized epilepsy

Dugan

Carlson²,

Bluvstein³

et al. 2014

Neurology

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Objective: We studied the frequency of auras in generalized epilepsy (GE) using a detailed semistructured diagnostic interview. Methods:In this cross-sectional study, participants with GE were drawn from the Epilepsy Phenome/Genome Project (EPGP). Responses to the standardized diagnostic interview regarding tonic-clonic (grand mal) seizures were then examined. This questionnaire initially required participants to provide their own description of any subjective phenomena before their "grand mal seizures." Participants who provided answers to these questions were considered to have an aura. All participants were then systematically queried regarding a list of specific symptoms occurring before grand mal seizures, using structured (closed-ended) questions.

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Focal clinical and electroencephalographic features in patients with juvenile myoclonic epilepsy

Abstract: Patients with JME showed focal clinical and EEG features. These features should not be misinterpreted as indicative of partial epilepsy.

Cited by 41 publications

References 30 publications

Juvenile Myoclonic Epilepsy in Rural Western India: Not Yet a Benign Syndrome

Juvenile Myoclonic Epilepsy in Rural Western India: Not Yet a Benign Syndrome

Widespread cortical morphologic changes in juvenile myoclonic epilepsy: Evidence from structural MRI

Auras in generalized epilepsy

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