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There is a high comorbidity between psychiatric disorders and juvenile myoclonic epilepsy (JME), observed in up to 58% of these patients; specifically, mood disorders, anxiety and personality disorders (PD). In some patients with PD there are nonspecific alterations in the EEG, which nevertheless sometimes involve pathology. The presence of personality disorders along with JME has been repeatedly described. Previous studies have emphasized the difficulties in treating patients with JME, which have been attributed to some specific psychiatric, psychological and psychosocial characteristics.
Objectives
Describing distinctive personality traits in JME
Methods
Review of scientific literature based on a relevant clinical case.
Results
19-year-old woman, single. Psychiatric history since she was 12 due to anxiety-depressive symptoms, after being diagnosed with JME. 4 admissions in Psychiatry, with a variety of diagnoses: eating disorder, attention deficit hyperactivity disorder and borderline personality disorder. The evolution of both disorders has been parallel, presenting epileptic seizures due to irregular therapeutic adherence together with pseudo-seizures, which made difficult their differential diagnosis. In addition, he has had frequent visits to the emergency room for suicide attempts and impulsive behaviors.
Conclusions
In 1957, for the first time, distinctive personality traits were described in patients with JME: lack of control and perseverance, emotional instability, variable self-concept and reactive mood, which have been confirmed in subsequent studies. It is believed as epilepsy progresses, patients tend to develop symptoms of depression, anxiety, social problems, and attention deficit. Therefore, these patients have difficulty in following medical recommendations, especially precautions regarding precipitating factors for seizures.
There were several reports in Japan on cases that had characteristic features of what is now called benign adult familial myoclonic epilepsy (BAFME). Patients with BAFME often had irregular fine dysrhythmic involuntary movement, which became evident on outstretched extended arms. One of the characteristics of BAFME was giant somatosensory evoked potential (G-SEP) with enhanced long-loop cortical reflexes and premovement cortical spikes by the jerk-locked averaging method, suggesting hyperexcitability of cerebral cortex. Differential diagnosis includes a variety of progressive myoclonus epilepsy, hereditary tremor, and idiopathic epilepsies such as juvenile myoclonic epilepsy (JME) and grand mal on awaking. Careful history-taking reveals that the BAFME family history had a dominant hereditary pattern of almost complete penetrance, which is unusual for idiopathic generalized epilepsy (IGE). The presence of involuntary hand tremor with seizure strongly suggests the diagnosis of BAFME.
This chapter deals with epilepsy in girls and young women, and reviews the common epilepsy syndromes, treatment challenges, and educational and social concerns. Some seizure disorders can be grouped together as an epilepsy syndrome. The epileptic syndromes that present in adolescence are juvenile absence epilepsy, juvenile myoclonic epilepsy (JME), and generalized tonic-clonic seizures on awakening. Decisions about treating seizures in children and adolescents involve considerations of when to treat, how long to treat, selection of the best medications to use, supplementation with vitamins, and compliance with the treatment plan. Knowledge of possible drug interactions is important, for the physician, the caretakers, and the girl with epilepsy. Some antiepileptic drugs (AEDs), for example phenytoin, alter the concentration of vitamin D in the body. Children and adolescents who have normal cognitive development include those with febrile seizures, childhood absence epilepsy, benign focal epilepsy (rolandic epilepsy) and JME.
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