Juvenile myoclonic epilepsy: A clinical and sleep EEG study

Abstract

Juvenile myoclonic epilepsy (JME) is characterized by myoclonic jerks on awakening, generalized tonic--clonic seizures (GTCS) and is associated with absence seizures in more than one third of cases. Fifteen patients with juvenile myoclonic epilepsy were studied with regard to their clinical profile, EEG data and sleep EEG findings. There was a delay in the diagnosis of JME (mean of 3.5 years) due to various reasons. Sleep deprivation was the most common precipitating factor for triggering seizures, followed by fatigue. Routine EEGs were abnormal in 73.33% of cases only and had misleading findings in 6.66%. Sleep EEGs were abnormal in 100% of cases with generalized spikes, polyspikes and slow wave discharges. Discharge rates on sleep EEGs typically increased significantly during the transition phase (i.e. the asleep to awakening stage) and we consider this to be a specific finding in appropriate clinical setting. Sleep EEGs are a more sensitive and specific tool for the diagnosis of JME while routine awake EEGs may miss or mislead.

Interrelationship of sleep and juvenile myoclonic epilepsy (JME): A sleep questionnaire‐, EEG‐, and polysomnography (PSG)‐based prospective case–control study

“…Sleep disturbances in patients with epilepsy may be secondary to AEDs, nocturnal seizures, or a concomitant sleep disorder such as sleep apnea or restless leg syndrome. The previous studies on JME and sleep have used patients on multiple AEDs or on polytherapy and EEG alone to analyze sleep [6,13]. The present study focused on patients with JME on VPA monotherapy vs. drug-naïve patients using sleep questionnaires, overnight PSG, and EEG.…”

“…The number of each ED event and duration was noted across all stages of sleep. The EDI (Epileptiform Discharge Index) per stage of sleep was calculated using the number of EDs in each sleep stage (in min) and ED rate by total EDs in min/sleep stage in min × 100 (modified from [13]). The presence of arousal in various stages of sleep and its relation with EDs and K-complexes were noted.…”

“…Gigli et al (1992) found higher CAP rates in 10 JME patients (46.7%) when compared to age-matched controls (23%) during all-night PSG recording [8]. Dhanuka et al studied sleep EEG findings in 15 patients to evaluate for abnormal IEDs, without an attempt to study sleep macrostructure [13]. The patients were either on various AEDs -single or multiple AEDs (n = 5) or drugnaïve (n = 9).…”

Juvenil myoklonusepilepsi

“…Hos 44 -81 % av pasientene finnes et patologisk EEG med utbrudd av generalisert 3 -6 Hz polyspike-waves som det mest typiske, noe som anses som patognomonisk for syndromet (26). Aktiviteten er mest uttalt frontalt.…”

“…40 % (27), og fokale patologiske endringer i EEG er rapportert å forekomme hos rundt 30 % (8 -55 %) (5,21,22,25). En slik fokalitet kan lett gi opphav til feil diagnose (26). Ved mistanke om juvenil myoklonusepilepsi bør det derfor tas EEG med flikkerstimulering, ev.…”