Progressive Myoclonic Epilepsies

Tracey - posted on 04/01/2010 ( 3 moms have responded )

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What is it like?

Here's a parent's view: "At first the doctors just thought Avi had a seizure because he was growing so fast. He had more grand mal seizures, and they started him on medication. Each drug seemed to work for a while and then it was as if his body became immune to it. They tried more and more drugs, two or three at a time, and the seizures just became more frequent. The worst part was that Avi was slipping—he was changing. He was not as sharp and quick as he had been. We blamed it on the drugs, but it just got worse and worse. Over a 3-year period, after the seizures began, Avi's mind seemed to get slower and slower. Then came the little seizures that would cause his speech to sputter and hesitate and his mind to turn on and off, like someone was taking a light switch and flicking it up and down."



Progressive myoclonic epilepsies feature a combination of myoclonic and tonic-clonic seizures. Unsteadiness, muscle rigidity, and mental deterioration are often also present.



Who gets it?

This is a group of rare disorders. Hereditary metabolic disorders are often responsible, but sometimes metabolic test results are normal and the cause remains unknown.



The disorders affect both sexes. The age of onset can vary from infancy to adulthood, depending upon the specific type of myoclonic epilepsy.



Tell me more

Progressive myoclonic epilepsy is not a single disorder but includes a group of syndromes with various names. Some of them are:



severe myoclonic epilepsy of infancy (Dravet syndrome)

Unverricht-Lundborg disease (also called Baltic myoclonus)

Lafora disease

mitochondrial encephalopathies

Genetic testing is available to identify most of the disorders.



How is it treated?

The medical treatment of progressive myoclonic epilepsy is often successful only for a few months or years. These patients may require more than one seizure medicine. As the disorder progresses, the medications become less effective, and side effects may be more severe as more of them are used at higher doses. **In such cases, it is often worthwhile to try lower doses.



Depakote (valproate)is most commonly used. Other seizure medicines used include Keppra (levetiracetam), Topamax (topiramate), Klonopin (clonazepam), and Zonegran (zonisamide). While Lamictal (lamotrigine)can be used, in rare patients the drug can make seizures worse. Neurontin (gabapentin), Tegretol/Carbatrol (carbamazepine), Trileptal(oxcarbazepine, and Dilantin (phenytoin) usually do not help and can worse the condition).



What's the outlook?

The outlook is generally unfavorable. Seizures are difficult to control and patients often lose abilities involving thinking and movement. However, the course of the various syndromes varies considerably from individual to individual.





Information provided by epilepsy.com

For more information on myoclonic seizures please go to epilepsy.com

Presented by Tracey Alderson, Administrator, Epilepsy Awareness 2009

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3 Comments

View replies by

Vanessa - posted on 02/27/2012

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Hi Tracey, my daughter Caitlin is 9 years old and she has "complete sub-cortical band heterotopia". We have been struggling with her seizures since she was 6. She got diagnosed at the age of four (she had her first seizure just before she turned four). We have tried many different medications, which all seem to work for a period of six months or less and then we're on to the next. We started her off on Epilim, but she had terrible mood swings, then we went on to Tegretol, which she was an angel on, but after six months on it, she reacted to it and started having drop seizures, so we then went on to lamotrigine. After a while we blended this with Clobazam, we've tried many more blends with the same result of them not working after a while of being on them, now she is on a mix of Clobazam, Lamotrigine, Ethosuximide, Keppra (Levetiracetam), Phenytoin and we've just included Resperidone into the mix as her moods are out of control at the moment (hitting, pinching, scratching, punching, kicking, yelling, screaming - I've never seen her like this before). She just came out of hospital last Wednesday, after being there for two weeks as she started having violent drop seizures (once again) and dropped onto concrete and split her head open (luckily only requiring three stitches). It's been a hard road and we're still struggling our way through it! She is developmentally at the age of a five year old. We also have many problems with constipation and she is so little (she is in the 2nd percentile for weight on the graph) and we're finding that getting her to eat is getting harder and harder, she is totally refusing to eat breakfast a the moment. We live in New Zealand and have been waiting for an operation that Caitlin is on the list for (but our health department keeps on declining it) which is the VNS (vagus nerve stimulator). Our doctors think we now have a pretty good argument for why Caitlin would be a top candidate for the operation due to her latest head injury from having a seizure. We don't even know if this operation will help her, but we've got to give her our everything. It's been hard to find someone else out there with the same "disability" as Caitlin... After reading your story, it has given me great hope that some day Caitlin can lead a (semi) normal life, not quite seizure free, but a lot less than she has been having (normally around 22 a day that we see plus all the twitches and absents on top of that)... thanks!

Tracey - posted on 09/09/2010

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Hi Kelly,

I can certainly understand where you're coming from. Epilepsy has many types and combinations of seizures that make up the various seizure disorders. However, your daughter could also be showing a combination of some signs of side effects from medication and having tonic clonic seizures. Also, keep in mind, she is getting to the age where it is possible her seizures could be being triggered by changes in hormones. Hormones - or the monthly cycle often affect seizure activity in women with epilepsy. And, as much as poor memory and repeating things are common in PME, it can also affect and causes problems with other epilepsies too. So it doesn't necessarily mean your daughter is developing PME.
My monthly cycle has always had an effect on my seizures. As a teen I had migraines and of course never considered until after I had my first tonic clonic seizure when I was 29, that there was a link. Or, that it's possible I was having absence seizures as a teenager - but missed connecting that it was epilepsy at the time. After I started having TC seizures, figuring out what medication was best took some time - nothing worked, I suffered side effects from everything, everytime I had a TC seizure it was like someone erased my memory and it took weeks - sometimes months to regain what I had lost and I knew the medication wasn't helping me speed up regaining my memory. Then if I had another seizure in between - I just felt like I was going nowhere - I wasn't able to function or think right anymore - I was having breakthrough TC seizures and trying to work and raise my family. Thankfully my husband knew I was perfectly intact psychologically because he knew me and my personality. But as soon as the drugs started affecting me and changing who I was as a person the doctors immediately were quick to blame the condition (the type of seizures) without considering the medication; or the possibility that the dose of medication was just too much for me to tolerate - or it may be the wrong medication for me altogether, in order to be able to function properly. My husband and I discussed lowering doses and removing certain drugs that were most likely interfering with my cognitive functions and insisted again and again until we found what worked for me.
And even though I have never had complete control of my epilepsy - mostly due to the type of my epilepsy (grey matter heterotopia - which in many cases is resistent to medication), I have regained full control of me - I am able to think, organize, remember much better and more clearly, I can function, and I feel sane again. And I've remained on one medication and on a lower dose for over 10 years now. As well, I only have my seizures during sleep now and they aren't very often anymore.

Try not to panic - it can get better - be positive. Maybe ask your specialist some questions regarding the dose from the medications that your daughter is on - or if it would be better to look at changing one of the medications. Just remember, there are usually side effects from most anti convulsants, and some are worse than others. I know Keppra can cause anxiety and psychiatric symptoms - affecting cognitive functions. And Lamictal can sometimes affect memory, and it has a list of other things too. So, even when side effects aren't listed for a particular med; if you feel a medication is reacting negatively make sure you address this with your specialist.
Also you can check online at the Wikipedia website for information on most medications or go to www.epilepsyontario.org or www.epilepsyfoundation.org

I hope this helps.
Good Luck & Take Care!

Sincerely
Tracey Alderson
Administrator, Epilepsy Awareness 2009

Kelly - posted on 09/04/2010

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I am a little freaked out after reading this article. My daughter had her first TC in May 2009. Since then she has had 2 more. She has JME and has been having issues with memory and concentration ever since. She started with Depakote, but it basically gave her ADD. We switched to Lamictal in Jan 2010 and added Keppra in June after another TC. I had her psych ed testing done in August and get the full results next week. I am very scared because her reading scores continue to go down, she has really gotten bad at repeating things. The psychologist put cognitive disorder secondary to epilepsy on her insurance form. Now I worried that it might be progressive as she seems to fit this profile. Can this happen at age 12 (she is 13 now)? Or is this something that we would have seen before adolescence.