ATEP 3750

Dr. Rehberg

JUVENILE MYOCLONIC
EPILEPSY
Ameer Shihadeh
Abstract
Introduction: this study will explain the cause of Juvenile myoclonic
epilepsy (JME) in a female freshman high school basketball player and traits
that indicates JME.
Case presentation: a fourteen year old female basketball player
experiences episodes of seizures months after she was diagnosed with a
concussion which prevented her to play the remainder of the basketball
season.
Results: subject did not experience any seizures after hospitalization and
was prescribed medication to reduce the risk of seizure reoccurrence.
Conclusion: sleep deprivation, stress, and incompliance to taking
medication are major factors that could make the subject relapse and
experience seizures once again. It is important to make lifestyle changes to
reduce episodes of seizures.

Introduction

Juvenile Myoclonic Epilepsy is a syndrome of idiopathic generalized

epilepsy. It is usually found in patients from ages 9-14. Polyspikes readings

from an EEG would indicate whether or not a person has JME. JME is when a

patient experiences a serious of different types of seizures, predominantly

myoclonic jerks and in rare cases, generalized tonic clonic seizures. There

are factors that influence a high prevalence of seizures among patients who

are positive in those factors. Also medication is a key contributor to the

remiss of seizures of any kind if taken regularly.

This study will explain possible outcomes that may have caused sprout

of JME in a female high school freshman basketball player. The factors that

would influence seizures, and what personality traits those who have JME

may possess will be discussed, as well as the importance of medication

throughout the process.

Literature Review
 Juvenile Myoclonic Epilepsy (JME) is a syndrome of idiopathic

generalized epilepsy (IGE), and can be found more often in the adolescent

and young adult years in ones life.1 Usually electroencephalography (EEG) is

the method that is used to diagnose a patient with any type of generalized

tonic clonic seizures (GTCS). Abnormal spike-waves or polyspikes and a

normal background is what is being measured.1 Abnormalities consists of

polyspike waves at 4-6 Hz in 30% of the cases with photosensitivity, and up

to 90% after photonic stimulation.2 JME has shown to be more prevalent in

females than in males, and should be genetically observed, for members of

the family may carry a trait of JME.3

JME can be characterized as seizures with single, bilateral or

repetitive, arrhythmic, irregular myoclonic jerks (MJ) In some instances, these

jerks may cause the patients to fall suddenly.4 MJs are spontaneous, brief,

and sudden. They are not associated with any changes of consciousness but

patients may report a lapse in attention or may feel absent for a moment.4

Typically, seizures occur upon awakening or may be due to sleep deprivation.

The precipitating factors that are commonly seen in JME patients is lack of

sleep which has been seen in 84% of the patients, stress, which 70% of

patients have said they have, also alcohol consumption can play a role in JME

in 51% of the patients.4

GTCS are present in 80-90% of JME patients, and are in most cases

medically referred.4 These episodes consist of longer than usual and a cluster
of MJs.4 The frequency and intensity are heightened and gradually dissolve

into the tonic phase of the GTCS episode.4

There is also a psychological aspect in diagnosing JME, some patients

who have JME have a peculiar personality profile and a social

maladjustment.5 Studies have shown that that there have been psychiatric

comorbidity, meaning that there are two chronic conditions the patient

currently obtain, and the psychiatric disorders are more prevalent in patients

who are antiepileptic drug-resistant.5 Other behaviors that have been noted

amongst JME patients are social problems, sleep or wake rhythm, impulsivity,

risk-taking and decision making behaviors. JME patients are considered to

have . . .an engaging, but emotionally unstable [and] fairly immature

personality. . ..5

JME management is usually handle through antiepileptic drugs (AED),

and remission will occur as long as the patients are compliant with taking

their medication. Those who refrain from using AED have a relapse rate of

over 90%.2 Lifelong treatment may be necessary despite the toxicity some of

these medication may cause, but treatment might have to be weighted

against the risk of relapsing and having reoccurring seizures. 2 A long-term

observational study has been conducted on 175 subjects who had JME. 62%

were seizure free for one year and 53% were seizure free for two on AED,

and the outcome of patients who experienced no episodes of any seizures

without the use AEDs for two years was 9%.2

Case Presentation
 January 12, 2016 a fourteen year old high school freshman girls

basketball player sustained a head injury and was diagnosed with a

concussion by her physician. She was forced to not participate for the rest of

the basketball season due to her concussion. Three months later after the

season had ended, the school was on spring break, during that time period

the subject had experienced two seizures. The subject was hospitalized after

the first seizure and was told that it was stress related. Although the

basketball season had ended, the subject was cleared from her concussion to

play in any sports. A few weeks later, the subject was hospitalized again for

the second seizure. A CAT scan was performed and the physician diagnosed

the subject with juvenile myoclonic epilepsy. The subject was prescribed a

drug called Keppra. Keppra is an anticonvulsant which is used to treat

epilepsy and subarachnoid hemorrhage. Although, the drug is more

commonly used for epilepsy.

Despite the subjects history of the concussion suffered, the doctor

explained to the subject and her mother that the concussion had no

correlation to why she experienced the seizures, for that the date she was

diagnosed with the concussion and the date from when she experienced the

seizures were too far apart.

The subject described her experience with her seizures and explained

that her first episode occurred in her sleep. The second episode occurred

while she was in the bathroom and collapsed on to the floor. The subject
complained of symptoms close to what would be symptoms of a concussion,

including sensitivity to light and headaches.

Results

After the subject told the head athletic trainer of her seizures, she

followed up with the athletic trainer two weeks later. She explained that she

had no seizures after she was prescribed Keppra. The athletic trainer wanted

to stress test the subject since she did not complete her post-concussion

stress test to return to play, but she decided that she did not want to

participate in sports anymore. Once the athlete stated she did not want to

play sports, she did not appear for anymore follow-ups based on her

condition.

Based on the limited information, the subject was classified to have no

relapses of seizures based on the follow-up time after the last hospitalization

of the subject.

Discussion

Because juvenile myoclonic epilepsy has no symptoms of its

prevalence in early childhood, it is hard to detect and treat for this disorder

at a young age. Most patients are unaware that they even experience MJs,

and do not take them as a serious indication of a disorder.4 Patients realize

that something is wrong when they are being hospitalized after their first

episode of GTCS, just like the case for the subject in this study.

Once a patient has been diagnosed with JME, it is much easier to spot

signs, knowing that they are now aware of their condition. Momentary MJs
can happen in a matter of seconds, these jerks are commonly symmetrical,

meaning that they occur simultaneously in both limbs. The subject in this

study had no recollect of whether or not she experienced any MJs or an

absence of time. Her first encounter of a seizure occurred in her sleep as

previously stated, but perhaps the subject experienced the seizure upon

awakening, for that is when it occurs the most.

The subject is a high school student and claims that she experiences a

lot of stress. Psychological aspects play a key role on how JME is managed a

strange personality or behavior pattern is typical for someone with JME.5 The

subject was not a troubled teen, although she was very aggressive, and at

some points found herself getting disciplined through the school for her

behavior. Her behavioral characteristics fit the description of someone who

has JME.

There is no known cure to JME, although medication suppress the

chances of seizing a great amount. Most patients do not seize or experience

any MJs if they adhere to their medication for years at a time.2 Although,

poor drug adherence could increase the amount of seizures a patient has.1

JME has an excellent response to treatment as long as the treatment is taken

regularly.1 Treatment plans and medication should be individualized based on

sex, gender, and comorbidities of other factors that could affect treatment.1

In order for the subject to decrease the amount of MJs or GTCS, she must find

methods to decrease her stress, be sure to have enough rest and sleep, and

to adhere to all the medications her physician gives her.

References
1. Asadi-pooya AA, Hashemzehi Z, Emami M. Predictors of seizure control

in patients with juvenile myoclonic epilepsy (JME). Seizure.

2014;23(10):889-91.
2. Hfler J, Unterberger I, Dobesberger J, Kuchukhidze G, Walser G, Trinka

E. Seizure outcome in 175 patients with juvenile myoclonic epilepsy--a

long-term observational study. Epilepsy Res. 2014;108(10):1817-24.

3. Cvetkovska E, Panov S, Kuzmanovski I. Clinical genetic study in juvenile

myoclonic epilepsy. Seizure. 2014;23(10):903-5.

4. Genton P, Thomas P, Kasteleijn-nolst trenit DG, Medina MT, Salas-puig

J. Clinical aspects of juvenile myoclonic epilepsy. Epilepsy Behav.

2013;28 Suppl 1:S8-14.

5. Syvertsen MR, Thuve S, Stordrange BS, Brodtkorb E. Clinical

heterogeneity of juvenile myoclonic epilepsy: follow-up after an interval

of more than 20 years. Seizure. 2014;23(5):344-8.