To the Editors:
We read with interest the article of Trinka et al. (2006) about the presence of psychiatric disorders in juvenile myoclonic epilepsy (JME). JME is a stable condition and is not associated with mental or neurologic deterioration. However, like other idiopathic epilepsies, JME may be fortuitously associated with brain abnormalities and/or mental retardation (Gelisse et al., 2000; Gelisse et al., 2001). Janz and Christian (1957), in their description of impulsive petit mal, noted that some patients had an “attractive but immature” personality that resulted in some difficulties of social adjustment, abnormal lifestyle, and low compliance: such findings rely on clinical experience but are rarely quantified. In our series of 170 consecutive JME patients referred to two departments of epileptology (Marseilles and Nice) between 1981 and 1998 (Gelisse et al., 2001), 26.5% had a lifetime history of some form of psychiatric disorder, versus 47% in the study of Trinka et al. Personality disorders were the most frequent finding and were detected in 14% (vs. 23% for Trinka et al.). A borderline personality, responsible for social maladjustment, represented the most frequent personality disorder in our study (6.5%), whereas no specific personality disorders were found in the study of Trinka et al.
Our study was retrospective, whereas the study of Trinka et al. is prospective and could explain in part the difference, but our population was larger. Both studies include patients with long follow-ups. To have a realistic evaluation of the real significance and of the actual prevalence of psychiatric disorders in JME, it would, however, be interesting to have controls in the general population, in other forms of epilepsy, and in other chronic neurologic disorders like migraine. Our overall impression is that JME, which is indeed associated with some degree of psychological and social dysfunction, remains, all things said, a comparatively benign disorder. The clinician should be prepared for some specific problems in the management of JME patients, but these should not be overrated!