MISDIAGNOSIS AND TREATMENT IN JUVENILE MYOCLONIC EPILEPSY

Of 1300 epileptic patients 76 (5.8%) were found to have juvenile myocl onic epilepsy (JME). These 76 patients were examined at the epilepsy o utpatient clinic of Bakirkoy State Hospital for Neurological and Psych iatric Diseases between 1991 and 1996 and data obtained were analysed retrospectively. Clinically typical absence seizures were reported in 40.8%, myoclonic jerks in 100%, and generalized tonic-clonic seizures in 82.9% of the patients. Neurological and mental examination was norm al for all patients with the exception of three cases; two with essent ial tremor and one with minimal dysarthria. Precipitating factors were noted in 85.5% of cases. Abnormal EEG was recorded in 73 (6.1%) patie nts. Abnormalities mainly consisted of generalized discharges of spike /polyspike and slow-wave (86.6%) and generalized paroxysmal theta or d elta (9.2%). Fifteen (19.7%) had focal abnormalities and 20 (26.4%) ha d photoconvulsive discharges. Of the 76 patients, 40 (52.6%) were not diagnosed at the initial interview; definite diagnosis was delayed by a mean of 5.9 years. As a result of misdiagnosis at the Initial interv iew 40 patients had been administered AED except for valproate. After reassessment of clinical and EEG findings, the medication was changed to valproate therapy. As a result, 65 of our JME patients (85.5%) were seizure free after a one-year follow-up period.