title: Provocative and inhibitory effects of a video-EEG neuropsychologic protocol in juvenile myoclonic epilepsy.
abstract: OBJECTIVE
  Studies suggest that higher cognitive functions could precipitate seizures in juvenile myoclonic epilepsy (JME). The present study aimed to analyze the effects of higher mental activity on epileptiform discharges and seizures in patients with JME and compare them to those of habitual methods of activation.
  
  
  METHODS
  Seventy-six patients with JME (41 female) underwent a video-EEG (electroencephalography) neuropsychologic protocol (VNPP) and habitual methods of activation for 4-6 h.
  
  
  RESULTS
  Twenty-nine of the 76 (38.2%) presented provocative effect, and inhibition was seen in 28 of 31 (90.3%). A mixed effect was observed in 11 (35.5%), and 30 patients (39.5%) suffered no effect of VNPP. Action-programming tasks were more effective than thinking in provoking epileptiform discharges (23.7% and 11.0% of patients, respectively, p = 0.03). Inhibitory effect was observed equally in the various categories of tasks, except in mental calculation, which had a higher inhibitory rate. Habitual methods of activation were more effective than VNPP in provoking discharges. Anxiety disorders were diagnosed in 24 of 58 patients (41.4%); anxious patients had greater discharge indexes and no significant inhibitory effect on VNPP.
  
  
  CONCLUSIONS
  Praxis exerted the most remarkable provocative effect, in accordance with the motor circuitry hyperexcitability hypothesis in JME. Inhibitory effect, which had no such task specificity, might be mediated by a widespread cortical-thalamic pathway, possibly involving the parietal cortex. The frequent inhibitory effect found under cortical activation conditions, influenced by the presence of anxiety, supports nonpharmacologic therapeutic interventions in JME.
authors.affiliation: Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil. mibit@ig.com.br
authors.forename: Mirian Salvadori Bittar
authors.initials: MS
authors.lastname: Guaranha
authors.forename: Patrícia
authors.initials: P
authors.lastname: da Silva Sousa
authors.forename: Gerardo Maria
authors.initials: GM
authors.lastname: de Araújo-Filho
authors.forename: Katia
authors.initials: K
authors.lastname: Lin
authors.forename: Laura Maria Figueiredo Ferreira
authors.initials: LM
authors.lastname: Guilhoto
authors.forename: Luís Otávio Sales Ferreira
authors.initials: LO
authors.lastname: Caboclo
authors.forename: Elza Márcia Targas
authors.initials: EM
authors.lastname: Yacubian
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology*; D002648:Child; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data*; D020195:Epilepsy, Reflex / Q000503:physiopathology; D005260:Female; D006613:Higher Nervous Activity / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020190:Myoclonic Epilepsy, Juvenile / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D009433:Neural Inhibition / Q000502:physiology; D009434:Neural Pathways / Q000503:physiopathology; D009484:Neuropsychology; D010296:Parietal Lobe / Q000503:physiopathology; D010775:Photic Stimulation; D015985:Precipitating Factors; D013647:Task Performance and Analysis; D013788:Thalamus / Q000503:physiopathology; D014741:Video Recording; D014743:Videotape Recording