The topographical distribution of epileptic spikes in juvenile myoclonic epilepsy with and without photosensitivity

- Epileptic spikes in photosensitive juvenile myoclonic epilepsy are prevalent in occipital areas.
- The location of the maximum of generalised abnormalities is not affected by photosensitivity.
- There are likely different epileptic networks in photosensitive and non-photosensitive JME.

ObjectiveUp to 30% of people with juvenile myoclonic epilepsy (JME) have photoparoxysmal responses (PPR). Recent studies report on structural and pathophysiological differences between people with JME with (JME+PPR) and without PPR (JME−PPR). We investigated whether electrophysiological features outside photic stimulation differ between these subtypes.MethodsWe analysed EEG recordings of people with JME at a tertiary epilepsy centre and an academic hospital. Photosensitivity was assessed in a drug-naïve condition. We compared the occurrence and involvement of posterior electrodes for focal abnormalities and generalised spike-wave activity in the EEG outside photic stimulation between JME+PPR and JME−PPR.ResultsWe included EEG recordings of 18 people with JME+PPR and 21 with JME−PPR. People with JME−PPR had less focal abnormalities in the posterior brain regions than people with JME+PPR (19% vs 55%, p < 0.05). There was no difference in the distribution of generalised spike-wave activity between people with JME+PPR and JME−PPR.ConclusionThis study demonstrates electrophysiological correlates of the previously described structural and physiological differences between JME+PPR and JME−PPR.SignificanceFindings support the hypothesis that posterior interictal EEG abnormalities reflect localised cortical hyperexcitability, which makes patients with JME more sensitive to photic stimuli.