Treatment and challenges with antiepileptic drugs in patients with juvenile myoclonic epilepsy

Abstract

Background: Patients with juvenile myoclonic epilepsy (JME) may have uncontrolled seizures. The purpose of this study was to investigate the use and challenges with antiepileptic drugs (AEDs) and the patients' view of these challenges. Method: A questionnaire about the use of AEDs, adherence to therapy, and quality of life was given to patients with JME recruited from Drammen Hospital. Data regarding AEDs were confirmed from medical records at Drammen Hospital, Norway (2007. Additional clinical interviews were performed, and a mixed method approach was applied. Results: Ninety patients with defined JME diagnosis, 54/36 women/men aged 14-39 (mean: 25) years, were included. Only 29 (33%) were seizure-free. Within the last year, 21% experienced generalized tonic-clonic seizures (GTCS), and 68% had myoclonic jerks. Seventy-six (84%) used AEDs, 78% in monotherapy. A total of 10 AEDs were used;: most commonly valproate (n = 33), lamotrigine (n = 27), and levetiracetam (n = 21). Two-thirds of valproate users were men while all other AEDs were used more in females than in men. Valproate and levetiracetam displayed better efficacy against GTCS than lamotrigine. One-third often/sometimes forgot their medication nonintentionally while 14% had intentional poor adherence. The majority reported good quality of life (76%). No significant correlations between the use of AEDs, use of valproate, poor adherence, quality of life score, and seizure freedom were demonstrated. Half of the patients had serum concentrations measured every year, and twothirds thought this was important. Qualitative interviews elucidated treatment challenges in JME;, adverse effect burden, adherence, and activities of daily life. Conclusion: Despite the use of AEDs in the majority of patients, only one-third were seizure-free. Other challenges included polypharmacy, the use of valproate in women, and variable adherence. This points to a need for closer follow-up in patients with JME.

Long-term prognosis of juvenile myoclonic epilepsy: A systematic review searching for sex differences

“…All were carried out in hospital-based settings. The majority (11, 44 %) were performed in Europe [17,[20][21][22]24,25,27,28,33,35,38], while seven (28 %) were performed in Asia [16,18,23,26,30,32,37], four (16 %) in South America [11,15,19,29], two (8 %) in North America [31,34], and one (4 %) in Africa [36]. All except one, written in Spanish [15], were in English.…”

“…Of the 25 articles analyzed, 20 included only patients with JME [11,[15][16][17][18][19][20][21][22][23][24][25][26][27]29,32,[35][36][37][38], three of them focusing on specific endophenotypes such as eye closure sensitivity (ECS) [19,26] and PI [11]. Among the other five studies [28,30,31,33,34], three included IGE samples [28,30,33], one specifically addressing photosensitive IGE [30], one enrolled patients with different types of adolescent-onset epilepsy, both focal and generalized [31], and the other included patients with pattern-sensitive epilepsy [34].…”

“…As regards the quality of the analyzed studies, 12 of the 25 (48 %) were defined "low RoB" [15,16,21,23,25,[27][28][29][32][33][34], 10 (40 %) "moderate RoB" [17][18][19][20]22,24,26,31,35,36], and 3 (12 %) "high RoB" [30,37,38] (Supplementary Table 1).…”

Safety and tolerability of antiepileptic therapy: emphasis on the use of valproates (literature review)

“…Головная боль, усталость и головокружение с равной частотой встречались при приеме этих АЭП [81]. Еще в одном недавно проведенном исследовании, оценивающем эффективность лечения ЮМЭ в клинической практике [46], у 48 % пациентов, получавших ламотриджин, отмечено отсутствие эффекта или аггравация миоклонических приступов. В 12 % случаев на фоне приема ламотриджина отмечено развитие аллергической сыпи.…”

The clinical spectrum of familial and sporadic idiopathic generalized epilepsy

“…Conversely, single gene variants with high effect size and Mendelian inheritance have also been described and likely explain the IGE phenotype in minority of patients. For instance, mutations in the GABRA1 gene cause a broad spectrum of symptoms ranging from severe epileptic encephalopathies to classical IGE (Johannessen Landmark et al, 2019;Maljevic et al, 2019).…”