[Clinical factors related to treatment resistance in juvenile myoclonic epilepsy]

Juvenile myoclonic epilepsy (JME) is one of the most representative idiopathic generalized epilepsies occurring in adolescence. Although epileptic seizures in JME are easily controlled by appropriate antiepileptic drug (AED) treatment, there have recently been several reports that approximately 15-20% of patients with JME are resistant to such treatment, despite an accurate diagnosis and choice of AEDs. In this study, we sought to identify risk factors that may lead to treatment resistance in patients with JME.

The subjects were 47 patients meeting the criteria of JME, and had been followed up for over 2 years. We retrospectively analyzed the response to treatment, and classified them into 3 groups: group 1 consisting of fully controlled cases (N = 33), group 2 of a true resistant case (N = 1), and group 3 of pseudoresistant cases (N = 13). The epileptic seizures in group 2 were difficult to control despite various AED treatments from the onset of epilepsy. Group 3 cases showed a recurrence of seizures despite excellent initial responses to AEDs. Among the group 3 cases, 4 patients showed a low compliance with AEDs because of poor recognition of their epilepsy, while the remaining 9 patients had serious psychosocial factors potentially aggravating the seizures.

Approximately 30% of patients with JME experienced a recurrence of seizures despite an appropriate choice of AEDs. Most of them were categorized into refractory JME due to various psychosocial factors. Our results suggest that seizure control and the quality of life in this group are improved by education, psychological treatment, and favorable life-styles.