juvenile myoclonic epilepsy

    
      Re: juvenile myoclonic epilepsy
    


[ Follow Ups ] [ Post Followup ] [ Neurology and Neurosurgery Forum ] [ FAQ ]



Posted by ccf neurology M.D. on November 07, 1997 at 22:53:07:

In Reply to: juvenile myoclonic epilepsy posted by Pennie White on October 10, 1997 at 22:55:43:
  some years ago i was diagnosed with juvenile myoclonic epilspsy. first i was given Dilantin, but when that didn't work, i was given Depakote.  the current dose i am on is 750mg twice a day and it seems to keep my seizures under control.  
  however, i am aware that Depakote can cause liver damage, which concerns me.  are there any other medications which can control my seizures?
  also, do you have any studies going concerning jme at this time, or will there be any in the future?
  one more question.  anytime i have surgery, it has been followed by siezures in spite of the fact that i'm taking my medication regularly.  this also happens when i take narcotic pain killers.  is there any way to avoid this as i may have to have major surgery soon?
  i thank you in advance for your help in these matters
--------------------------------------------------------------------------------------------------------------------
Juvenile myoclonic epilepsy is now known to be an inherited form of epilepsy, which in many (but not all) cases localizes to the 6th human chromosome. The disorder typically begins in the teenage years and incorporates myoclonic seizures, which are irregular solitary or multiple jerks, especially when awakening, generallized tonic-clonic seizures (so called "grand mal" seizures), and sometimes atypical absence seizures. Depakote is BY FAR the very best medication to treat this disorder, because it is the only medication that is effective aginst all the different types of seizures that can occur in this form of epilepsy. About 85% of patients with JME are well controlled with Depakote. Side effect of Depakote include weight gain, tremor, decreased platelets in the blood, and liver damage. Fortunately the liver damage is almost never serious in adults, and is in reality only a problem for chilren less than 2 years of age on more than one epilepsy drug. Anyone old enough to get JME need not be concerned--- if your liver enzyme count was to rise, a brief reduction in the dose or level of the medication would almost assuredly fix the problem. It is frequent for patients with epilepsy to have seizures around the time of major surgeries. There are many reasons for this. One is that the anesthetic drugs themselves affect how quickly the liver metabolizes drugs like Depakote. Other medications given around the time of surgery may also cause the drug level to fluctuate. Another reason is that often the medication is not given in the morning before surgery---- always be sure you are getting your regular dose of medication the morning of surgery, even though your not supposed to be eating or drinking anythimg. Fortunately, this should not be a problem much longer for Depakote, because a new intravenous version of the drug has just been released, and whatever you cannot take by mouth can now be given by IV. Careful monitoring of drug levels daily around the time of a surgery is helpful.
Unfortunately, even if all of these things I have mentioned are paid attention to and adjusted properly, you can still have seizures anyway, simply because surgery is a MAJOR stress on the body and brain, and increases the risk of seizures the same way drinking alcohol or staying up all night and becoming exhausted would.
I would be sure that your neurologist is actively involved in the perioperative management of your seizures. Maybe with the new IV form of the drug you may get lucky and not have ANY next time!!!

Good Luck
Remember, information that we provide on the forum is intended for general informational purposes, and is in no way, shape, or form a substitute for your own treating physicians. Actual diagnosis and management of your specific condition should be strict;y in accordance with these treating physicians.