Diagnostic and therapeutic approach to drug-resistant juvenile myoclonic epilepsy.
Michele AscoliGiovanni MastroianniSara GaspariniPasquale StrianoVittoria CianciSabrina NeriValentina BovaAnna MammìAntonio GambardellaAngelo LabateUmberto AgugliaEdoardo FerlazzoPublished in: Expert review of neurotherapeutics (2021)
About 30% of JME patients are drug-resistant. Valproate (VPA) is considered the first-choice drug. In women of childbearing potential, levetiracetam (LEV) should represent the first-choice treatment. Alternative monotherapy or add-on therapy should be considered in subjects with resistant seizures after the exclusion of pseudo-drug resistance. The choice of the add-on ASM depends on the predominant seizure type. In subjects with persistent bilateral tonic-clonic seizures, LEV or lamotrigine should be firstly considered. In patients with difficult-to-treat myoclonic seizures, clonazepam or LEV are recommended. In case of persistent absences, ethosuximide should be considered. With appropriate selection and safeguards in place, VPA should remain available as an option in women of childbearing potential whose seizures are resistant to other treatments.
Keyphrases
- drug resistant
- multidrug resistant
- temporal lobe epilepsy
- acinetobacter baumannii
- polycystic ovary syndrome
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- emergency department
- combination therapy
- prognostic factors
- randomized controlled trial
- peritoneal dialysis
- adipose tissue
- pseudomonas aeruginosa
- risk assessment
- climate change
- pregnant women
- clinical trial
- human health
- case report
- bone marrow