The Neuropsychiatric Burden in Juvenile Myoclonic Epilepsy: How Comorbidities Influence Treatment Response — Experience from a Tertiary Referral Center in LATAM
Stefan Narváez-Labuhn1, Juan Carlos Vera-López1, Maximiliano Salgado-Deza1, Fernando Vasquez Lopez1, Salvador Martínez-Medina1, Katherin Milagros Plasencia Correa1, Mariana Peschard-Franco1, Andres Morcillo Muñoz1, Mario A. Sebastian-Diaz2, Iris E. Martínez Juárez1
1Epilepsy Clinic & Clinical Epileptology Fellowship, National Institute of Neurology and Neurosurgery and UNAM, Mexico city, Mexico, 2Department of Nephrology, Central South High Specialty Hospital
Objective:
To explore the association between psychiatric comorbidities and the number of antiseizure medications (ASMs) in patients with juvenile myoclonic epilepsy (JME), and to evaluate whether these comorbidities increase the likelihood of requiring polytherapy and reduce seizure freedom.
Background:
Juvenile myoclonic epilepsy (JME) represents between 5-10% of all epilepsies and close to 18% of the idiopathic generalized epilepsies, with a prevalence of approximately 1/1,000 persons. It is characterized by myoclonus, generalized tonic-clonic seizures and absences. Although SANAD II determined that valproic acid is usually effective, the presence of psychiatric comorbidities can compromise the therapeutic response and promote drug resistance.
Design/Methods:
We conducted a cross-sectional study of 145 patients with JME evaluated at the National Institute of Neurology and Neurosurgery. Clinical and demographic features, seizure types, ASM regimens, and psychiatric comorbidities diagnosed under DSM-5 criteria were recorded. Seizure freedom was defined as absence of any seizure type for ≥12 months. Associations between psychiatric burden, ASM number, and seizure control were analyzed using chi-square tests, ordinal correlations, and multivariable comparisons adjusted for key demographic and clinical covariates (p < 0.05).
Results:
Among 145 participants (Mean age 28 ± 8 years), 58% (n=84) had at least one psychiatric comorbidity. Depression and personality disorders were significantly associated with lower seizure freedom (Global p = 0.019) and higher ASM load (r = 0.19, p = 0.024). Increasing number of ASMs inversely correlated with seizure control across seizure types (p ≤ 0.002).
Conclusions:
Psychiatric comorbidities, particularly depression, emerge as core correlates of treatment resistance in JME. Higher pharmacologic load mirrors both disease severity and psychiatric burden, suggesting that neuropsychiatric mechanisms may perpetuate drug refractoriness. These findings are complemented by a parallel analysis from the same JME cohort exploring the bidirectional relationship between depression and seizure freedom (“The Neuropsychiatric Loop in JME”).
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