MODIFICAZIONI DELL'ATTIVITA INTERCRITICA DURANTE VEGLIA E SONNO NOTTURNO IN UN PZ CON EPILESSIA MIOCLONICA GIOVANILE DI JANZ DI TIPO SCOTOSENSIBILE-NON FOTOSENSIBILE

Variations of interictal epileptic activity (IEA) during wakefulness and different sleep stages were studied in a newly diagnosed untreated patient with juvenile myoclonic epilepsy (JME). Frequency of typical polyspike-and-wave (PSW) complexes varied according to wakefulness and sleep stages. The rate of IEA was high during wakefulness before sleep, increased during nocturnal spontaneous awakenings and became maximum during final morning awakening. Among NREM sleep stages, activation was maximal during stages III and IV, whereas REM sleep completely abolished IEA. Awakenings following deep NREM sleep were very activating if no REM sleep was interposed. Awakenings from light NREM sleep were much less activating. No IEA was present in awakenings closely following REM sleep. Eye-closure, especially after final awakening, constantly elicited a PW discharge, often associated to massive myloclonic jerks (more pronounced in the upper limbs) and to EMG activity time related to polyspikes. On the contrary, eye-opening inhibited such manifestations. Intermittent photic stimulation was ineffective. After one month therapy with VPA (1200 mg/day), the patient presented a complete clinical and EEG remission. Our data are partially inconsistent with previous reports. This discrepancy could be related either to the fact that other studies included only patients under therapy, or to the presence of scotosensitivity without photosensitivity (less severe clinical subgroup?).