Evolution of juvenile myoclonic epilepsy treated from the outset with sodium valproate

Sodium valproate (VPA) is considered the first choice drug in juvenile myoc lonic epilepsy (JME). We have analysed the longterm evolution of 22 patient s treated from the outset with VPA. The following inclusion criteria were applied: (1) unequivocal diagnosis of JME; (2) treatment should be initiated with VPA monotherapy; and (3) follo w-up for more than 5 years. Twenty-two patients (15 females, seven males) were studied and their EEG re cordings were analysed. Their mean age was 28 years (range: 20-40 years) an d their mean follow-up was 7.7 years (range: 5-17 years). Four of them suff ered persistent seizures despite optimal VPA dosage and needed the addition of a second drug (lamotrigine in three cases, clobazam in one case). All o f our patients who continued their treatment are seizure-free. VPA effectiv ely controlled all seizures in 80% of patients. The discontinuation of drug therapy lead to a very high rate of relapses. With accurate diagnosis and appropiate therapy, seizures in JME can be effe ctively controlled. VPA is a very effective antiepileptic drug in controlli ng the seizures of JME, but many patients relapse after VPA discontinuation . Thus, JME may require lifelong therapy. (C) 2001 BEA Trading Ltd.