eMedicine Specialties > Neurology > Seizures and Epilepsy

Epilepsy, Juvenile Myoclonic: Multimedia

Author: Jose E Cavazos, MD, PhD, FAAN, Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, University of Texas Health Science Center at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center; Director of the Epilepsy Center, Audie L Murphy Veterans Affairs Medical Center
Coauthor(s): Mark Spitz, MD, Professor, Department of Neurology, University of Colorado Health Sciences Center
Contributor Information and Disclosures

Updated: Jan 7, 2010

Multimedia

Findings in a man with a history of generalized t...Media file 1: Findings in a man with a history of generalized tonic-clonic seizures (mostly nocturnal) and myoclonic jerks (mostly in the morning) since the age of 14 years. Carbamazepine exacerbated his myoclonic seizures. Sleep-deprived EEG was digitally recorded and then plotted by using an analog paper machine. The patient was getting drowsy when this burst of polyspike and slow wave was recorded.
Findings in a man with a history of generalized t...

Findings in a man with a history of generalized tonic-clonic seizures (mostly nocturnal) and myoclonic jerks (mostly in the morning) since the age of 14 years. Carbamazepine exacerbated his myoclonic seizures. Sleep-deprived EEG was digitally recorded and then plotted by using an analog paper machine. The patient was getting drowsy when this burst of polyspike and slow wave was recorded.

More on Epilepsy, Juvenile Myoclonic

Overview: Epilepsy, Juvenile Myoclonic
Differential Diagnoses & Workup: Epilepsy, Juvenile Myoclonic
Treatment & Medication: Epilepsy, Juvenile Myoclonic
Follow-up: Epilepsy, Juvenile Myoclonic
Multimedia: Epilepsy, Juvenile Myoclonic
References

References

  1. Herpin TH. Des asces incomplets de l'epilepsie. J Balliere et Fils. 1867.

  2. Rabot T. De la myoclonia epileptique. Paris, France: Medical thesis; 1899.

  3. Lundborg H. Die Progresive Myoklonusepilepsie (Unverricht's Myoklonie). Stockholm, Sweden: Almqvist & Wiksell; 1903.

  4. Janz D, Mathes A. Die Propulsiv Petit Mal Epilepsie. New York, NY: Garger; 1955.

  5. Janz D, Christian W. Impulsive petit mal. Deutsche Leitschrift f Nervenheilkunde. 1957;176:346-386.

  6. Lund M, Reintoft H, Simonsen N. Ein kontrolleret social og psychologisk Undersgelse af Patienter med Juvenil Myoklon Epilepsi. Ugeskr Laeg. 1975;137:2415-18.

  7. Bradley CA, Taghibiglou C, Collingridge GL, Wang YT. Mechanisms involved in the reduction of GABAA receptor alpha1-subunit expression caused by the epilepsy mutation A322D in the trafficking-competent receptor. J Biol Chem. Aug 8 2008;283(32):22043-50. [Medline].

  8. Macdonald RL, Kang JQ. Molecular Pathology of Genetic Epilepsies Associated with GABA(A) Receptor Subunit Mutations. Epilepsy Curr. Jan-Feb 2009;9(1):18-23. [Medline].

  9. Ciumas C, Wahlin TB, Jucaite A, Lindstrom P, Halldin C, Savic I. Reduced dopamine transporter binding in patients with juvenile myoclonic epilepsy. Neurology. Sep 9 2008;71(11):788-94. [Medline].

  10. Delgado-Escueta AV. Advances in genetics of juvenile myoclonic epilepsies. Epilepsy Curr. May-Jun 2007;7(3):61-7. [Medline].

  11. Kinirons P, Rabinowitz D, Gravel M, Long J, Winawer M, Sénéchal G, et al. Phenotypic concordance in 70 families with IGE-implications for genetic studies of epilepsy. Epilepsy Res. Nov 2008;82(1):21-28. [Medline].

  12. Hirano Y, Oguni H, Funatsuka M, Imai K, Osawa M. Differentiation of myoclonic seizures in epileptic syndromes: a video-polygraphic study of 26 patients. Epilepsia. Jun 2009;50(6):1525-35. [Medline].

  13. Baykan B, Altindag EA, Bebek N, Ozturk AY, Aslantas B, Gurses C, et al. Myoclonic seizures subside in the fourth decade in juvenile myoclonic epilepsy. Neurology. May 27 2008;70(22 Pt 2):2123-9. [Medline].

  14. Sadleir LG, Scheffer IE, Smith S, Carstensen B, Carlin J, Connolly MB, et al. Factors influencing clinical features of absence seizures. Epilepsia. Dec 2008;49(12):2100-7. [Medline].

  15. Badawy RA, Macdonell RA, Jackson GD, Berkovic SF. Why do seizures in generalized epilepsy often occur in the morning?. Neurology. Jul 21 2009;73(3):218-22. [Medline].

  16. Filho GM, Rosa VP, Lin K, Caboclo LO, Sakamoto AC, Yacubian EM. Psychiatric comorbidity in epilepsy: a study comparing patients with mesial temporal sclerosis and juvenile myoclonic epilepsy. Epilepsy Behav. Jul 2008;13(1):196-201. [Medline].

  17. Piazzini A, Turner K, Vignoli A, Canger R, Canevini MP. Frontal cognitive dysfunction in juvenile myoclonic epilepsy. Epilepsia. Apr 2008;49(4):657-62. [Medline].

  18. Iqbal N, Caswell HL, Hare DJ, Pilkington O, Mercer S, Duncan S. Neuropsychological profiles of patients with juvenile myoclonic epilepsy and their siblings: a preliminary controlled experimental video-EEG case series. Epilepsy Behav. Mar 2009;14(3):516-21. [Medline].

  19. Wallace R. Identification of a new JME gene implicates reduced apoptotic neuronal death as a mechanism of epileptogenesis. Epilepsy Curr. Jan-Feb 2005;5(1):11-3. [Medline].

  20. Suzuki T, Delgado-Escueta AV, Aguan K, et al. Mutations in EFHC1 cause juvenile myoclonic epilepsy. Nat Genet. Aug 2004;36(8):842-9. [Medline].

  21. Conte FF, Ribeiro PA, Marchesini RB, Pascoal VD, Silva JM, Oliveira AR, et al. Expression Profile and Distribution of Efhc1 Gene Transcript During Rodent Brain Development. J Mol Neurosci. Feb 4 2009;[Medline].

  22. Suzuki T, Miyamoto H, Nakahari T, Inoue I, Suemoto T, Jiang B, et al. Efhc1 deficiency causes spontaneous myoclonus and increased seizure susceptibility. Hum Mol Genet. Mar 15 2009;18(6):1099-109. [Medline].

  23. Bai D, Bailey JN, Durón RM, Alonso ME, Medina MT, Martínez-Juárez IE, et al. DNA variants in coding region of EFHC1: SNPs do not associate with juvenile myoclonic epilepsy. Epilepsia. May 2009;50(5):1184-90. [Medline].

  24. Medina MT, Suzuki T, Alonso ME, Durón RM, Martínez-Juárez IE, Bailey JN, et al. Novel mutations in Myoclonin1/EFHC1 in sporadic and familial juvenile myoclonic epilepsy. Neurology. May 27 2008;70(22 Pt 2):2137-44. [Medline].

  25. Pal DK, Evgrafov OV, Tabares P, et al. BRD2 (RING3) is a probable major susceptibility gene for common juvenile myoclonic epilepsy. Am J Hum Genet. Aug 2003;73(2):261-70. [Medline].

  26. de Kovel CG, Pinto D, de Haan GJ, Kasteleijn-Nolst Trenité DG, Lindhout D, Koeleman BP. Association analysis of BRD2 (RING3) and epilepsy in a Dutch population. Epilepsia. Nov 2007;48(11):2191-2. [Medline].

  27. Lin K, Jackowski AP, Carrete H Jr, de Araújo Filho GM, Silva HH, Guaranha MS, et al. Voxel-based morphometry evaluation of patients with photosensitive juvenile myoclonic epilepsy. Epilepsy Res. Oct 2009;86(2-3):138-45. [Medline].

  28. Tae WS, Kim SH, Joo EY, Han SJ, Kim IY, Kim SI, et al. Cortical thickness abnormality in juvenile myoclonic epilepsy. J Neurol. Apr 2008;255(4):561-6. [Medline].

  29. Roebling R, Scheerer N, Uttner I, Gruber O, Kraft E, Lerche H. Evaluation of cognition, structural, and functional MRI in juvenile myoclonic epilepsy. Epilepsia. Jun 1 2009;[Medline].

  30. Kim JH, Lee JK, Koh SB, Lee SA, Lee JM, Kim SI, et al. Regional grey matter abnormalities in juvenile myoclonic epilepsy: a voxel-based morphometry study. Neuroimage. Oct 1 2007;37(4):1132-7. [Medline].

  31. Pulsipher DT, Seidenberg M, Guidotti L, Tuchscherer VN, Morton J, Sheth RD, et al. Thalamofrontal circuitry and executive dysfunction in recent-onset juvenile myoclonic epilepsy. Epilepsia. May 2009;50(5):1210-9. [Medline].

  32. de Araújo Filho GM, Lin K, Lin J, Peruchi MM, Caboclo LO, Guaranha MS, et al. Are personality traits of juvenile myoclonic epilepsy related to frontal lobe dysfunctions? A proton MRS study. Epilepsia. May 2009;50(5):1201-9. [Medline].

  33. Deppe M, Kellinghaus C, Duning T, Möddel G, Mohammadi S, Deppe K, et al. Nerve fiber impairment of anterior thalamocortical circuitry in juvenile myoclonic epilepsy. Neurology. Dec 9 2008;71(24):1981-5. [Medline].

  34. [Guideline] Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, et al. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia. Sep 2009;50(9):2147-53. [Medline].

  35. Lin K, Carrete H Jr, Lin J, Peruchi MM, de Araújo Filho GM, Guaranha MS, et al. Magnetic resonance spectroscopy reveals an epileptic network in juvenile myoclonic epilepsy. Epilepsia. May 2009;50(5):1191-200. [Medline].

  36. de Araújo Filho GM, Jackowski AP, Lin K, Guaranha MS, Guilhoto LM, da Silva HH, et al. Personality traits related to juvenile myoclonic epilepsy: MRI reveals prefrontal abnormalities through a voxel-based morphometry study. Epilepsy Behav. Jun 2009;15(2):202-7. [Medline].

  37. Akgun Y, Soysal A, Atakli D, Yuksel B, Dayan C, Arpaci B. Cortical excitability in juvenile myoclonic epileptic patients and their asymptomatic siblings: a transcranial magnetic stimulation study. Seizure. Jul 2009;18(6):387-91. [Medline].

  38. Sadleir LG, Scheffer IE, Smith S, Carstensen B, Farrell K, Connolly MB. EEG features of absence seizures in idiopathic generalized epilepsy: impact of syndrome, age, and state. Epilepsia. Jun 2009;50(6):1572-8. [Medline].

  39. Lu Y, Waltz S, Stenzel K, Muhle H, Stephani U. Photosensitivity in epileptic syndromes of childhood and adolescence. Epileptic Disord. Jun 2008;10(2):136-43. [Medline].

  40. Santiago-Rodríguez E, Harmony T, Cárdenas-Morales L, Hernández A, Fernández-Bouzas A. Analysis of background EEG activity in patients with juvenile myoclonic epilepsy. Seizure. Jul 2008;17(5):437-45. [Medline].

  41. Specchio N, Boero G, Michelucci R, Gambardella A, Giallonardo AT, Fattouch J, et al. Effects of levetiracetam on EEG abnormalities in juvenile myoclonic epilepsy. Epilepsia. Apr 2008;49(4):663-9. [Medline].

  42. Labate A, Ambrosio R, Gambardella A, Sturniolo M, Pucci F, Quattrone A. Usefulness of a morning routine EEG recording in patients with juvenile myoclonic epilepsy. Epilepsy Res. Oct 2007;77(1):17-21. [Medline].

  43. Park KI, Lee SK, Chu K, Lee JJ, Kim DW, Nam H. The value of video-EEG monitoring to diagnose juvenile myoclonic epilepsy. Seizure. Mar 2009;18(2):94-9. [Medline].

  44. Stefan H, Paulini-Ruf A, Hopfengärtner R, Rampp S. Network characteristics of idiopathic generalized epilepsies in combined MEG/EEG. Epilepsy Res. Aug 2009;85(2-3):187-98. [Medline].

  45. Westphal-Guitti AC, Alonso NB, Migliorini RC, da Silva TI, Azevedo AM, Caboclo LO, et al. Quality of life and burden in caregivers of patients with epilepsy. J Neurosci Nurs. Dec 2007;39(6):354-60. [Medline].

  46. Sullivan JE, Dlugos DJ. Idiopathic Generalized Epilepsy. Curr Treat Options Neurol. May 2004;6(3):231-242. [Medline].

  47. Specchio LM, Gambardella A, Giallonardo AT, Michelucci R, Specchio N, Boero G, et al. Open label, long-term, pragmatic study on levetiracetam in the treatment of juvenile myoclonic epilepsy. Epilepsy Res. 2006;71(1):32-39. [Medline].

  48. Noachtar S, Andermann E, Meyvisch P, Andermann F, Gough WB, Schiemann-Delgado J. Levetiracetam for the treatment of idiopathic generalized epilepsy with myoclonic seizures. Neurology. Feb 19 2008;70(8):607-16. [Medline].

  49. Rosenfeld WE, Benbadis S, Edrich P, Tassinari CA, Hirsch E. Levetiracetam as add-on therapy for idiopathic generalized epilepsy syndromes with onset during adolescence: analysis of two randomized, double-blind, placebo-controlled studies. Epilepsy Res. Jul 2009;85(1):72-80. [Medline].

  50. Sharpe DV, Patel AD, Abou-Khalil B, Fenichel GM. Levetiracetam monotherapy in juvenile myoclonic epilepsy. Seizure. Jan 2008;17(1):64-8. [Medline].

  51. Verrotti A, Cerminara C, Coppola G, Franzoni E, Parisi P, Iannetti P, et al. Levetiracetam in juvenile myoclonic epilepsy: long-term efficacy in newly diagnosed adolescents. Dev Med Child Neurol. Jan 2008;50(1):29-32. [Medline].

  52. Morris GL, Hammer AE, Kustra RP, Messenheimer JA. Lamotrigine for patients with juvenile myoclonic epilepsy following prior treatment with valproate: results of an open-label study. Epilepsy Behav. Aug 2004;5(4):509-12. [Medline].

  53. Wheless JW, Clarke DF, Arzimanoglou A, Carpenter D. Treatment of pediatric epilepsy: European expert opinion, 2007. Epileptic Disord. Dec 2007;9(4):353-412. [Medline].

  54. Prasad A, Kuzniecky RI, Knowlton RC, et al. Evolving antiepileptic drug treatment in juvenile myoclonic epilepsy. Arch Neurol. Aug 2003;60(8):1100-5. [Medline].

  55. Kothare SV, Valencia I, Khurana DS, et al. Efficacy and tolerability of zonisamide in juvenile myoclonic epilepsy. Epileptic Disord. Dec 2004;6(4):267-70. [Medline].

  56. Nicolson A, Appleton RE, Chadwick DW, Smith DF. The relationship between treatment with valproate, lamotrigine, and topiramate and the prognosis of the idiopathic generalised epilepsies. J Neurol Neurosurg Psychiatry. Jan 2004;75(1):75-9. [Medline].

  57. Tóth V, Rásonyi G, Fogarasi A, Kovács N, Auer T, Janszky J. Juvenile myoclonic epilepsy starting in the eighth decade. Epileptic Disord. Sep 2007;9(3):341-5. [Medline].

  58. [Best Evidence] Camfield CS, Camfield PR. Juvenile myoclonic epilepsy 25 years after seizure onset: a population-based study. Neurology. Sep 29 2009;73(13):1041-5. [Medline].

  59. Aliberti V, Grunewald RA, Panayiotopoulos CP, Chroni E. Focal electroencephalographic abnormalities in juvenile myoclonic epilepsy. Epilepsia. Mar-Apr 1994;35(2):297-301. [Medline].

  60. Atakli D, Sozuer D, Atay T, et al. Misdiagnosis and treatment in juvenile myoclonic epilepsy. Seizure. Feb 1998;7(1):63-6. [Medline].

  61. Biton V, Montouris GD, Ritter F, et al. A randomized, placebo-controlled study of topiramate in primary generalizedtonic-clonic seizures. Topiramate YTC Study Group. Neurology. Apr 22 1999;52(7):1330-7. [Medline].

  62. Buchanan N. The use of lamotrigine in juvenile myoclonic epilepsy. Seizure. Jun 1996;5(2):149-51. [Medline].

  63. Canevini MP, Mai R, Di Marco C, et al. Juvenile myoclonic epilepsy of Janz: clinical observations in 60 patients. Seizure. Dec 1992;1(4):291-8. [Medline].

  64. Delgado-Escueta AV, Enrile-Bacsal F. Juvenile myoclonic epilepsy of Janz. Neurology. Mar 1984;34(3):285-94. [Medline].

  65. Delgado-Escueta AV, Greenberg DA, Treiman L, et al. Mapping the gene for juvenile myoclonic epilepsy. Epilepsia. 1989;30 Suppl 4:S8-18; discussion S24-7. [Medline].

  66. Delgado-Escueta AV, Serratosa JM, Liu A, et al. Progress in mapping human epilepsy genes. Epilepsia. 1994;35 Suppl 1:S29-40. [Medline].

  67. Dreifuss FE. Juvenile myoclonic epilepsy: characteristics of a primary generalized epilepsy. Epilepsia. 1989;30 Suppl 4:S1-7 discussion S24-7. [Medline].

  68. Durner M, Janz D, Zingsem J, Greenberg DA. Possible association of juvenile myoclonic epilepsy with HLA-DRw6. Epilepsia. Sep-Oct 1992;33(5):814-6. [Medline].

  69. Gram L, Alving J, Sagild JC, Dam M. Juvenile myoclonic epilepsy in unexpected age groups. Epilepsy Res. Mar-Apr 1988;2(2):137-40. [Medline].

  70. Grunewald RA, Panayiotopoulos CP. Juvenile myoclonic epilepsy. A review. Arch Neurol. Jun 1993;50(6):594-8. [Medline].

  71. International League Against Epilepsy. Proposal for classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia. May-Jun 1985;26(3):268-78. [Medline].

  72. Janz D. Epilepsy with impulsive petit mal (juvenile myoclonic epilepsy). Acta Neurol Scand. Nov 1985;72(5):449-59. [Medline].

  73. Janz D. Juvenile myoclonic epilepsy. Epilepsy with impulsive petit mal. Cleve Clin J Med. 1989;56 Suppl Pt 1:S23-33; discussion S40-2. [Medline].

  74. Janz D. The grand mal epilepsies and the sleeping-waking cycle. Epilepsia. Mar 1962;3:69-109. [Medline].

  75. Kleveland G, Engelsen BA. Juvenile myoclonic epilepsy: clinical characteristics, treatment and prognosis in a Norwegian population of patients. Seizure. Feb 1998;7(1):31-8. [Medline].

  76. Knott C, Panayiotopoulos CP. Carbamazepine in the treatment of generalised tonic clonic seizures in juvenile myoclonic epilepsy [letter]. J Neurol Neurosurg Psychiatry. Apr 1994;57(4):503. [Medline].

  77. Lancman ME, Asconape JJ, Penry JK. Clinical and EEG asymmetries in juvenile myoclonic epilepsy. Epilepsia. Mar-Apr 1994;35(2):302-6. [Medline].

  78. Meencke HJ, Janz D. Neuropathological findings in primary generalized epilepsy: a study of eight cases. Epilepsia. Feb 1984;25(1):8-21. [Medline].

  79. Meencke HJ, Janz D. The significance of microdysgenesia in primary generalized epilepsy: an answer to the considerations of Lyon and Gastaut. Epilepsia. Jul-Aug 1985;26(4):368-71. [Medline].

  80. Obeid T, Panayiotopoulos CP. Juvenile myoclonic epilepsy: a study in Saudi Arabia. Epilepsia. May-Jun 1988;29(3):280-2. [Medline].

  81. Oguni H, Mukahira K, Oguni M, et al. Video-polygraphic analysis of myoclonic seizures in juvenile myoclonic epilepsy. Epilepsia. Mar-Apr 1994;35(2):307-16. [Medline].

  82. Panayiotopoulos CP, Obeid T, Tahan AR. Juvenile myoclonic epilepsy: a 5-year prospective study. Epilepsia. Mar-Apr 1994;35(2):285-96. [Medline].

  83. Panayiotopoulos CP, Obeid T, Waheed G. Differentiation of typical absence seizures in epileptic syndromes. A video EEG study of 224 seizures in 20 patients. Brain. Aug 1989;112 ( Pt 4):1039-56. [Medline].

  84. Panayiotopoulos CP, Tahan R, Obeid T. Juvenile myoclonic epilepsy: factors of error involved in the diagnosis and treatment. Epilepsia. Sep-Oct 1991;32(5):672-6. [Medline].

  85. Pedersen SB, Petersen KA. Juvenile myoclonic epilepsy: clinical and EEG features. Acta Neurol Scand. Mar 1998;97(3):160-3. [Medline].

  86. Penry JK, Dean JC, Riela AR. Juvenile myoclonic epilepsy: long-term response to therapy. Epilepsia. 1989;30 Suppl 4:S19-23; discussion S24-7. [Medline].

  87. Shinnar S, Berg AT, Moshe SL, et al. Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol. May 1994;35(5):534-45. [Medline].

  88. Wirrell EC, Camfield CS, Camfield PR, et al. Long-term prognosis of typical childhood absence epilepsy: remission or progression to juvenile myoclonic epilepsy. Neurology. Oct 1996;47(4):912-8. [Medline].

Further Reading

Keywords

JME, idiopathic generalized epileptic syndrome, myoclonic jerks, generalized tonic-clonic seizures, GTCSs, absence seizures

Contributor Information and Disclosures

Author

Jose E Cavazos, MD, PhD, FAAN, Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, University of Texas Health Science Center at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center; Director of the Epilepsy Center, Audie L Murphy Veterans Affairs Medical Center
Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Neurological Association, and Society for Neuroscience
Disclosure: Nothing to disclose.

Coauthor(s)

Mark Spitz, MD, Professor, Department of Neurology, University of Colorado Health Sciences Center
Mark Spitz, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, and American Epilepsy Society
Disclosure: pfizer Honoraria Speaking and teaching; ortho-mcneil Honoraria Review panel membership

Medical Editor

Ramon Diaz-Arrastia, MD, PhD, Assistant Professor, Department of Neurology, Comprehensive Epilepsy Center, University of Texas Southwestern
Ramon Diaz-Arrastia, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, New York Academy of Sciences, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.