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Ecstasy and the dance of death.

1992; BMJ; Volume: 305; Issue: 6844 Linguagem: Inglês

10.1136/bmj.305.6844.5

0959-8138

John A. Henry,

Diabetes and associated disorders

the short arm of chromosome 6.6 Autosomal recessive inheritance has been proposed as its mode of transmission,67 but further confirmation is awaited.At present it seems likely that other factors, possibly other genes, modify the expression of a juvenile myoclonic epilepsy gene on chromosome 6.The recognition that non-pharmacological factors, such as emotional stress, sleep deprivation, alcohol use, and menses, seem to precipitate seizures',3 allows patients to gain some control of their seizures; most patients, however, will require treatment with drugs.Unfortunately, no prospective, con- trolled studies of drug treatment for juvenile myoclonic epilepsy have been performed and current information on use of anticonvulsant drugs has been derived exclusively from retrospective studies and anecdotal reports.8Currently the drug of choice is sodium valproate,9 which completely suppresses seizures in 80-90% of patients.7 Treatment of those patients who respond poorly to valproate is difficult and often requires more than one antiepileptic drug.No other single drug stands out as the ideal second line agent.Though anecdotal reports suggest that most other anticonvulsant drugs may be helpful, overall results are disappointing.In many patients carbamazepine exacerbates myoclonus and juvenile myoclonic epilepsy.'"'3Juvenile myoclonic epilepsy usually persists throughout life, and patients in their seventh decade have been reported.Attempted drug withdrawal, even after complete suppression of seizures for two or more years, leads to relapses in 80-90% ofpatients.' 28 It is therefore important that a correct diagnosis is made so that patients with juvenile myoclonic epilepsy may be advised that treatment is usually required life long.