Abstracts

Rationale: Background: Progressive Myoclonic Epilepsies represent a group of epilepsies characterized by different seizure types, ataxia, cognitive impairment and myoclonus. These epilepsies are often pharmacologically challenging to treat based on the progressive nature of the disorders. Methods: Case Report: We present a case of a 42 year-old, right-handed woman who developed epilepsy at approximately age 10. For several years, she was thought to have juvenile myoclonic epilepsy (JME), as her events were described as generalized tonic-clonic seizures, myoclonic jerks with occasional atonic episodes, and absence seizures. However, she continued to have worsening of her events, which is inconsistent with JME, therefore, genetic testing was done. She was found to have progressive myoclonic epilepsy type 1. The severity of her events then worsened to the point of being nearly wheelchair-bound secondary to injuries sustained with her atonic events. She has tried several medications in the past with therapeutic blood levels, including: depakote, topamax, keppra, and lamictal. Also, she had a vagal nerve stimulator placed approximately seven years ago with no drastic change in myoclonic events. In September of 2009, the patient was placed on lacosamide. Results: Since addition of lacosamide, she and her caregiver have reported a drastic decrease in the myoclonic events, from hourly events before the addition of lacosamide, to approximately three events weekly currently. Also, and we believe most importantly, she has reported a change in her speech with less stuttering and pausing. She reports that a cloud has been lifted and she is able to think more clearly. Conclusions: Lacosamide is a relatively new medication and its efficacy in different kinds of epilepsy is yet to be discovered. We present a case of a patient with progressive myoclonic epilepsy, for whom lacosamide has drastically decreased the number of myoclonic events and has had perceived assistance with cognition.