title: Modulation of epileptiform EEG discharges in juvenile myoclonic epilepsy: an investigation of reflex epileptic traits.
abstract: OBJECTIVE
  Previous studies have suggested that cognitive tasks modulate (provoke or inhibit) the epileptiform electroencephalography (EEG) discharges (EDs) in patients with juvenile myoclonic epilepsy (JME). Their inhibitory effect was found to be especially frequent (64-90%). These studies arbitrarily defined modulation as a >100% increase or >50% decrease of the EDs compared with baseline, which may not sufficiently distinguish from spontaneous fluctuations. The aim of our study was to assess the modulation of EDs and the precipitation of myoclonic seizures by cognitive tasks and by conventional provocation methods, taking into account also the spontaneous fluctuation of EDs.
  
  
  METHODS
  Sixty patients with JME underwent video-EEG recordings including 50-min baseline, sleep, hyperventilation, intermittent photic stimulation (IPS), and cognitive tasks. To account for spontaneous fluctuations of the EDs we divided the baseline period into 5-min epochs and calculated the 95% confidence interval for the baseline EDs in each patient. Modulation was assumed when the number of EDs during any 5-min test period was outside the 95% confidence interval.
  
  
  RESULTS
  Using the arbitrary method, our results were similar to previous publications: Cognitive tasks seemed to inhibit the EDs in 94% of the patients, and to provoke them in 22%. However, when the spontaneous fluctuations were accounted for, inhibition was found in only 29% of the patients and provocation in 18%. A nonspecific effect of any cognitive task seemed to account for the observed significant inhibition in two-thirds of the cases, but was observed in only one of the patients with significant provocation. Photoparoxysmal response was observed in 23% of the patients. When accounting for the spontaneous occurrence of EDs, IPS had provocative effect in 10% of the patients. Hyperventilation and sleep had provocative effect on EDs to an extent similar to the cognitive tasks (hyperventilation: 22%; sleep: 18%). The conventional provocation methods tended to be more efficient in patients who were not seizure free. Myoclonia were recorded most often during the cognitive tasks (10 patients).
  
  
  CONCLUSIONS
  Spontaneous fluctuations of EDs account for most of the previously described inhibitory effect of the cognitive tasks. The provocative effect of the cognitive tasks is task-specific, whereas the inhibitory effect seems to be related to cognitive activation in general.
authors.affiliation: Department of Clinical Neurophysiology, Danish Epilepsy Centre, Visbys Allé 5, Dianalund, Denmark. sbz@filadelfia.dk
authors.forename: Sándor
authors.initials: S
authors.lastname: Beniczky
authors.forename: Mirian Salvadori Bittar
authors.initials: MS
authors.lastname: Guaranha
authors.forename: Isa
authors.initials: I
authors.lastname: Conradsen
authors.forename: Mamta Bhushan
authors.initials: MB
authors.lastname: Singh
authors.forename: Veronika
authors.initials: V
authors.lastname: Rutar
authors.forename: Bogdan
authors.initials: B
authors.lastname: Lorber
authors.forename: Patricia
authors.initials: P
authors.lastname: Braga
authors.forename: Alicia Bogacz
authors.initials: AB
authors.lastname: Fressola
authors.forename: Yushi
authors.initials: Y
authors.lastname: Inoue
authors.forename: Elza Márcia Targas
authors.initials: EM
authors.lastname: Yacubian
authors.forename: Peter
authors.initials: P
authors.lastname: Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D058256:Brain Waves / Q000187:drug effects / Q000502:physiology*; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology*; D004569:Electroencephalography; D020195:Epilepsy, Reflex / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006985:Hyperventilation; D007266:Inhibition, Psychological; D008297:Male; D008875:Middle Aged; D020190:Myoclonic Epilepsy, Juvenile / Q000188:drug therapy / Q000503:physiopathology*; D009483:Neuropsychological Tests; D012890:Sleep / Q000502:physiology; D014743:Videotape Recording; D055815:Young Adult
chemical_list: D000927:Anticonvulsants