Abstracts

Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized epilepsy. Patients with JME are very sensitive to precipitants factors (PF) such as sleep deprivation, excess of alcohol intake, and photic stimulation. More recently, other unusual PF, such as praxis, reading, writing, calculating, decision-making, speaking and playing musical instruments have been identified in patients with JME. Activation of specific cortical areas of the brain by cognitive stimuli is known to induce seizure in patients with JME.
To examine the effects of higher mental activity in patients with JME, monitored with video-EEG during neuropsychological activation. Sixty-one patients with JME (35 females), treated and non-treated, underwent video-EEG recording during performance of neuropsychological tasks, which involved reading, speaking, writing, written and mental arithmetic calculation, and spatial construction. These tasks were compared to other activation methods during video-EEG: photic stimulation, hyperventilation, opening/closure of the eyes, and sleep after the tasks (without sleep deprivation). All but 7 patients were treated with anti-epileptic drugs at the time of video-EEG examination. Overall, 18 patients (29.5%) had epileptiform discharges (ED) activation during at least one neuropsychological task. All non-treated patients had ED activation related to these tasks. Among 54 treated patients, 11 (20.4%) showed EEG activation. When photic stimulation and hyperventilation were included as activation methods, 35 patients (57.5%) showed increase of ED in EEG. Praxis was the most effective task (11 patients) followed by reading and writing (6) and mathematic calculation (4). Seizure was precipitated during the tests in 28 (45,9%) patients; the most common were myoclonus (22 patients [ndash] 36.1%). Neuropsychological EEG activation is a useful instrument in the evaluation of treated and non-treated JME patients. It may confirm the existence of PFs and identify reflex seizures in these patients. (Supported by CAPES and FAPESP from Brazil and DAAD from Germany.)