We studied myoclonic seizures (MS) in 5 patients with juvenile myoclonic epilepsy (JME) using video polygraphic recordings to investigate the clinical characteristics of MS in this epileptic syndrome. The total number of MS analyzed was 302 (range 27-125, mean 60) seizures per patient. MS occurred either singly or repetitively (37 vs. 63%) and corresponded to generalized bilaterally synchronous single or multispike-and-wave complexes at 3-5 Hz. Video analysis of the myoclonic jerks demonstrated that either distal or proximal muscle involvement predominated. In the former, there was mild bilateral flexion and some external rotation of the forearms. In the latter, flexion of both arms at the elbow, flexion and abduction of the thighs, and extension of the back was observed. Asymmetry of MS was noted in 4 of 5 patients. Facial involvement of MS occurred infrequently in 2 patients. When the patients kept both arms outstretched, the arms dropped or there was sudden interruption of ongoing electromyographic (EMG) potentials immediately after myoclonic jerks (postmyoclonic inhibition) in all patients. One should inquire about these clinical characteristics of MS in JME when taking a thorough history in patients with primary generalized tonic-clonic seizures (GTC).

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Summary: Recent progress in surgical intervention for mcdically refractory epilepsy has hclped to shed light on more complex epileptogcnic problems in children and infants. Surgical treatment increasingly is being used in pediatric patients, but the indications for surgery in this age group have not been well dcfincd. The developing child with a seizure disordcr has sevcral problems that are dilferent from adults, such as neural plasticity, dclctcrious effccts of seizures on developmental status, and spontaneous resolution of cpilcpsy. The critical age for irreversiblc brain dysfunction and the timing of surgery arc the main issues for thc treatment of children. Thus, carlier surgical intervention is generally recommended to prevent further detrimental seizure effccts, but we still do not know the optimal age. Until the establishment of guidelines for pediatric cpilcpsy surgery, surgical indications should be determined by the prognosis and the presence of a rescctahlc cpilcptogcnic rocus, which in turn are bascd on the localization of the epileptic focus, seizure frequency, scvcrity, and cognitive function of each case, rather than just the patient's age.

S270K. Akada et al. Table 1. The mean (s.d.) of the BDI, SDS and Overall Psychosocial Functioning Scale of the WPSI BDI SDS WPSI ~~ Total cases (n = 23) 9.9 (9.1) 37.3 (9.4) 24.3 (12.0) Partial epilepsy (n = 27) 11.9 (8.8) 39.0 (9.4) 27.0 (1 1.4) Generalized epilepsy (n = 6) 0.8 (1.6) 30.0 (5.2) 12.2 (5.9) BDI, Beck's Depression Inventory; SDS, Self-rating Depression Scale; WPSI, Washington Psychosocial Seizure Inventory. DISCUSSIONThe MMPI scales that showed remarkable correlation with depressive symptoms on the BDI and SDS were D, Pa, Pt, Sc and Si. In the present study, the nature of depressive state was again related to the psychological factors. On the other hand, the influence of seizure frequency was relatively small. The Pepressive tendency in our subjects was not necessarily significant when the mean values of all the cases were considered. However, it should be kept in mind that there was a group of patients with a severely depressed state. Accordingly, we should pay attention to the latent depressive tendency in epileptics. Our results emphasize the necessity of the psychotherapeutical approach in the medical care of epilepsy. Figure 2. The correlation of each battery. Scales with higher correlation coefficient (> 0.6) were combined with each other. FB, family background; EA, emotional adjustment; IA, interpersonal adjustment; VA, vocational adjustment; FS, financial status; AS, adjustment to seizures; MM, medicine and medical management scale of the WPSI. REFERENCES 1. Hosokawa J, Fukuma M, Kugoh T, Suwaki H, Hosokawa K. Depressive symptoms in patients with epilepsy. ]pn. ] . Psychialr Neurof. 1992; 4 6 449-451. Kugoh T, Fukuma M, Hosokawa J et al. Depressive symptoms among ambulant epileptics leading ordinary social life. Qin. Psychi-