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Patients with JME have greater than 90% chance of experiencing recurrent seizures Therefore, lifelong treatment with antiepileptic drugs (AEDs) and avoidance of possibly provoking factors (e g , alcohol, illicit drugs, sleep deprivation, and flickering lights) are recommended Therapeutic agents effective against seizures in generalized epilepsies should be used and are usually very effective in controlling seizures Currently, lamotrigine, levetiracetam, topiramate, zonisamide, and valproic acid (VPA in males), are considered first-line treatment . VPA is typically avoided

Epilepsy Surgery Eeg

T4-T6 I

CD T3

FIGURE 32.1

EEG demonstrating 4-6 Hz generalized spike-wave and polyspike-wave discharges.

in young women because of cosmetic and hormonal adverse effects, teratogenicity, and an increased likelihood of cognitive problems in children who were exposed to it in utero Long-acting benzodiazepines, such as clonazepam or clobazam, are also effective, but have the potential for tolerance and addiction . Most patients (80-90%) are controlled on a single agent (i.e. , monotherapy), but some require combination therapy Several drugs used for partial-onset seizures can exacerbate seizures and even cause status epilepticus in patients with JME (e .g . , phenytoin, carbamazepine, oxcarbazepine, gabapentin, tiagabine, and vigabatrin), and should not be used

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