Juvenile myoclonic epilepsy with multiple sclerosis: is there a dual role for valproate?

A 27-year-old woman was diagnosed with juvenile myoclonic epilepsy since the age of 13 and was on valproate therapy. She had a single episode of demyelinating illness while on valproate therapy. Two years earlier, her medication was changed to lamotrigine to avoid the teratogenic effects of valproate, after which the frequency of her demyelinating events increased to four episodes in 1.5 years, satisfying the revised McDonald criteria for multiple sclerosis. Valproate has been shown to restore T-cell homoestasis and ameliorate pathogenesis of experimental allergic encephalomyelitis, a mouse model of multiple sclerosis. Therefore, we propose a potential dual role of valproate in patients with co-existent juvenile myoclonic epilepsy and multiple sclerosis.