title: Factors associated with lack of response to valproic acid monotherapy in juvenile myoclonic epilepsy.
abstract: OBJECTIVE
  To determine factors associated with lack of response to valproic acid (VPA) in juvenile myoclonic epilepsy (JME).
  
  
  METHODS
  Retrospective analysis of clinical and EEG data of 201 patients with JME who had at least 3 years follow up was performed. Psychiatric evaluation was performed using ICD-10 by structured clinical interview. Patients were divided into two groups: VPA responders (seizure free for 2 or more years) and those with lack of response to VPA. Effect size for non-response and correlations for variables significantly different between the groups was performed, the findings were confirmed by ROC curves.
  
  
  RESULTS
  The mean duration of follow up was 7.75 (range 3-12) years; 55.2% were males. Focal semiologic features were noted is 16%. EEG was abnormal in 67%; focal EEG abnormalities were noted in 32.8%. Coexisting psychiatric disorders (PDs) were found in 33.3%. Lack of response to VPA was noted in 19%. Diagnosis of PDs and focal EEG abnormalities significantly increased the risk of VPA non-responsiveness by 5.54 (95% CI of 2.60-11.80; p<0.0001) and 3.01 times respectively (95% CI of 1.40-6.47; p<0.008). Diagnosis of PDs showed significant correlation (r=0.332; p<0.0001) and association (AUC 0.700; p<0.0001) with lack of response to VPA. Though focal EEG abnormalities increased the chances, it did not correlate with lack of response to VPA.
  
  
  CONCLUSIONS
  Lack of response to VPA was noted 19% of patients with JME. Coexisting PDs showed significant correlation and association with lack of response to VPA.
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India. Electronic address: sita_js@hotmail.com.
authors.forename: Sita
authors.initials: S
authors.lastname: Jayalakshmi
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Sudhindra
authors.initials: S
authors.lastname: Vooturi
authors.affiliation: Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Bana
authors.affiliation: Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Sarva
authors.initials: S
authors.lastname: Sailaja
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Shanmukhi
authors.initials: S
authors.lastname: Somayajula
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Surath
authors.initials: S
authors.lastname: Mohandas
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology*; D008609:Mental Status Schedule; D020190:Myoclonic Epilepsy, Juvenile / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015898:Tomography Scanners, X-Ray Computed; D014635:Valproic Acid / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid
keywords: Focal EEG abnormality; Juvenile myoclonic epilepsy; Lack of response to valproic acid; Psychiatric disorder.