Clinical and Neuropsychological Considerations in a Case of Unrecognized Myoclonic Epileptic Jerks Dramatically Controlled by Levetiracetam

Abstract

The International League Against Epilepsy (ILAE) classification recognizes 2 forms of myoclonic epilepsy with a good prognosis: benign myoclonic epilepsy of infancy (BMEI) and juvenile myoclonic epilepsy (JME); recent studies confirm the efficacy of levetiracetam (LEV) in treating idiopathic generalized epilepsies (IGE) in patients with myoclonic seizures. We report a girl referred to our Child Neuropsychiatry Unit at age 9 years because of massive myoclonic jerks, previously diagnosed as tics. Neuropsychological examination evidenced mild cognitive impairment. The clinical and electroencephalogram (EEG) data led to diagnosis of BMEI with late presentation. A dramatic suppression of interictal and ictal epileptiform activity was achieved after only one intake of LEV. Another neuropsychological examination after 6 months of treatment showed performance improvement probably related to EEG modifications. LEV may be suitable for the first-line treatment of myoclonic idiopathic seizures.

Key words

childhood - epilepsy - levetiracetam

References

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1 Digit Span test-retest reliability=0.75 after 23 days in sample of 353 children aged 6−15 years (WISC-III); Coloured Progressive Matrices test-retest mean reliability=0.90 after 3 months in the population aged 6.6−12.6 years; Corsi Block Tapping Test test-retest mean reliability=0.60 (forward), 0.74 (backward); VMI test-retest mean reliability=0.87 after 3 months in a sample of 122 children aged 6−10 years.

2 Standard Points with mean value=100 and standard deviation=15; 77 is equivalent to mild deficit.

3 Cognitive assessment with WISC-III was not repeated because of insufficient time for test-retest reliability; we have no time to go into more depth with neuropsychological evaluation.

Correspondence