Abstracts

Rationale: Juvenile myoclonic epilepsy (JME) is idiopathic epilepsy responding well to valproate (VPA) but usually requiring a lifelong therapy. The use of the newer anti-epileptics to substitute valproate is still investigational for which this study aimed to assess if levetiracetam (LEV) monotherapy is effective in JME.Methods: This is a retrospective chart review of patients who were newly diagnosed with JME between June 2011 and May of 2013. The treating neurologist elected to use the appropriate antiepileptic of choice, but only patients with the initial therapy of valproate (VPA) or levetiracetam (LEV) were included, with minimum of a 1 year follow.Results: 30 newly diagnosed cases with JME were included. There were 20 women (67%), with a mean age at epilepsy onset of 15 years (range; 10-26), and a mean age at presentation of 20 years (range; 14-30 years). MRI brain was normal in all patients except one (none-specific white matter changes), and EEG showed polyspikes and slow waves in all except 3 patients. LEV monotherapy was initiated in 17 patients and VPA in 13 patients. Over the follow up period, 8 of the patients in each group were seizure free (47 vs 67%, p = 0.57), rare myoclonic jerks were observed in 4 patients on LEV and 3 on VPA (24 vs 25%, p = 97). 1 patient in each group required a second AED to achieve seizure freedom (6 vs 8%, p = 0.8). Finally, 4 patients on LEV and 1 on VPA continued to have seizures despite adding another appropriate antiepileptic (24 vs 8% p= 0.25). LEV and VPA were both well tolerated.Conclusions: LEV monotherapy was an effective and well-tolerated treatment of newly diagnosed cases with JME when compared to the standard therapy. Such a finding would support the need to consider LEV monotherapy in patients with JME, yet a larger study, preferably double blinded, will validate such an observation.