A Patient’s Journey

Juvenile myoclonic epilepsy

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e360 (Published 26 January 2012)
Cite this as: BMJ 2012;344:e360

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The courage and resilience of the patient’s journey described in “Juvenile Myoclonic Epilepsy” is an encouragement to all people with epilepsy (1). The authors state that the patient was lucky to have avoided valproate during pregnancy because of its teratogenicity, having been seizure free on a low dose. She was in fact on no medication during her first pregnancy, and ineffective treatment during the second pregnancy. Leaving a person with JME without medication or seizure control is risky and problematic, unless this is the explicit and informed choice of the patient.

Our obligation to warn patients about the risks of seizures, particularly convulsions, and the risk of SUDEP, should be emphasised. It does not stop when a woman contemplates having children, or becomes pregnant. The confidential enquiry into maternal deaths (2) tragically demonstrates that seizures during pregnancy can be fatal. We have a duty of care to make sure that protecting the foetus does not blind us to warning patients about the risks of seizures, and the increased risks of untreated, or ineffectively treated, active epilepsy.

Heather Angus-Leppan, Consultant Neurologist and Epilepsy Lead, Royal Free Hospital, London

1. Morrison N, Thomas R, Smith P. A patient’s journey. Juvenile myoclonic epilepsy. BMJ 2012;344:e360 (4 February).
2. Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG 2011;118(Suppl. 1): 1–203.

Competing interests: None declared

Heather Angus-Leppan, Consultant Neurologist and Epilepsy Lead

Royal Free Hospital, Pond St. London NW3 2QG

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