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Medication

Medication Summary

The goal of pharmacotherapy is to reduce morbidity and prevent complications.

The US Food and Drug Administration (FDA) has not approved any anticonvulsant solely for the treatment of juvenile myoclonic epilepsy (JME). In 2006, the FDA approved the adjunctive use of levetiracetam for the treatment of JME. Divalproex sodium has been approved as adjunctive therapy for patients with multiple seizure types that include absence seizures. However, many patients with JME do not have absence seizures.

In most patients with JME, seizures are well controlled with monotherapy. Valproic acid has been considered the treatment of choice for JME for many years, but epileptologists are increasingly using other choices as first-line therapies, including leviteracetam monotherapy. Approximately 90% of patients with JME become seizure free with valproate monotherapy.

Class Summary

Anticonvulsants are the mainstay of therapy for JME. These agents are given to prevent myoclonic jerks or seizures, generalized tonic-clonic seizures (GTCSs), and absence seizures.

Valproic acid

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Increases levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the brain.

Generics are available in rapid-release capsules, oral solution, and IV formulations.

Studies of combination therapy suggest that in practice, patients starting divalproex monotherapy need a low starting dose and target doses close to about 10 mg/kg/d. In the elderly, clearance of unbound drug is decreased; lowered doses are needed. Children often require higher doses per weight than adults do; some children given combination therapy (with enzyme-inducing antiepileptic drugs [EIAEDs]) may need doses as high as 60 mg/kg/day.

Divalproex sodium (Depakote, Depakote ER, Depakote Sprinkles)

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Divalproex sodium is indicated for monotherapy or adjunctive therapy in both focal-onset and generalized-onset seizures and adjunctively in many seizure types, including absence seizures. In clinical practice, it is often a first-line anticonvulsant in JME. It is metabolized to valproic acid.

Depakote and generics are available as delayed-release capsules, tablets, and sprinkles.

Lamotrigine (Lamictal)

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Lamotrigine is FDA-approved as monotherapy and add-on therapy in patients with focal-onset seizures and as add-on therapy only in patients with generalized tonic-clonic seizures and patients with Lennox-Gastaut syndrome (LGS); it is also indicated for conversion to monotherapy after failure of at least 1 enzyme-inducing antiseizure medication (eg, carbamazepine, phenytoin, phenobarbital). Several reports suggest that it is efficacious in JME and some of its seizure types; the present authors found benefit in some patients.

Lamotrigine is a well-tolerated anticonvulsant; it requires slow up-titration because of the risk of rash. It probably has fewer cognitive (ie, sedative) effects than most anticonvulsants do; some patients with JME have worsening of myoclonic jerks at low doses. In most patients, increasing the dose results in clinically significant improvement.

Serum concentrations of lamotrigine are useful in monitoring compliance and adjusting the dose; a few months into treatment, serum concentrations may decrease slightly because of enzymatic inducement in the liver. Conversion from enzyme-inducing antiseizure medications can be faster than recommended. Conversion from (or add-on therapy with) valproic acid requires slow titration because valproic acid inhibits metabolism of lamotrigine. Starting at high doses may increase the incidence of rash.

No IV formulation is available.

Topiramate (Topamax, Eprontia, Trokendi XR, Qudexy XR)

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Topiramate is indicated and FDA-approved as monotherapy and adjunctive therapy for adults and children aged 2 years and older with focal-onset seizures or primary GTCSs. It is also approved as add-on therapy for patients with Lennox-Gastuat syndrome (LGS). Some patients with JME have primary GTCSs, but may also have myoclonic and absence seizures. Topiramate is available as 25-, 100-, or 200-mg tablets and as 15-. 25-, 50-, 100-, 150-, or 200-mg sprinkle capsules. An oral solution (Eprontia) is also available. Extended-release capsules (Trokendi XR) are available for children aged 6 years and older.

Zonisamide (Zonegran)

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Zonisamide is indicated for adjunctive treatment of focal-onset seizures with or without secondary generalization. Evidence suggests effectiveness in myoclonic and other generalized seizure types as well.

It may stabilize neuronal membranes by acting at sodium and calcium channels. Zonisamide does not affect GABA activity.

Levetiracetam (Keppra, Keppra XR, Elepsia XR, Spritam)

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Levetiracetam is indicated as adjunctive therapy for myoclonic seizures in adults and adolescents and in primary GTCSs in addition to the treatment of focal-onset seizures. Levetiracetam is also approved specifically as adjunctive therapy for JME. The medication comes in many forms including oral solution, tablet (extended release, short acting, and disintegrating), and IV. The mechanism of action is unknown but is presumed to involve binding to the SV2A site in synaptic terminals.

Perampanel (Fycompa)

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Perampanel is indicated as adjunctive treatment for patients with generalized tonic-clonic seizures aged 12 years and older. The medication is available as both a suspension and a tablet. It is a noncompetitive antagonist of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor on post-synaptic neurons. Glutamate is a primary excitatory neurotransmitter in the CNS and is implicated in various neurological disorders caused by neuronal overexcitation.

Clobazam (ONFI, Sympazan)

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Clobazam is indicated as adjunctive treatment for seizures associated with Lennox-Gastaut syndrome (LGS), but can be used off-label as an adjunctive treatment for patients with refractory epilepsy as it is a broad spectrum antiseizure medication.

Herpin TH. Des asces incomplets de l'epilepsie. J Balliere et Fils. 1867.
Rabot T. De la myoclonia epileptique. Paris, France: Medical thesis; 1899.
Lundborg H. Die Progresive Myoklonusepilepsie (Unverricht's Myoklonie). Stockholm, Sweden: Almqvist & Wiksell; 1903.
Janz D, Mathes A. Die Propulsiv Petit Mal Epilepsie. New York, NY: Garger; 1955.
Janz D, Christian W. Impulsive petit mal. Deutsche Leitschrift f Nervenheilkunde. 1957. 176:346-386.
Lund M, Reintoft H, Simonsen N. Ein kontrolleret social og psychologisk Undersgelse af Patienter med Juvenil Myoklon Epilepsi. Ugeskr Laeg. 1975. 137:2415-18.
Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia. 1989 Jul-Aug. 30(4):389-99. [QxMD MEDLINE Link].
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. 2008 Aug 8. 283(32):22043-50. [QxMD MEDLINE Link].
Macdonald RL, Kang JQ. Molecular Pathology of Genetic Epilepsies Associated with GABA(A) Receptor Subunit Mutations. Epilepsy Curr. 2009 Jan-Feb. 9(1):18-23. [QxMD MEDLINE Link]. [Full Text].
Ciumas C, Wahlin TB, Jucaite A, Lindstrom P, Halldin C, Savic I. Reduced dopamine transporter binding in patients with juvenile myoclonic epilepsy. Neurology. 2008 Sep 9. 71(11):788-94. [QxMD MEDLINE Link].
Delgado-Escueta AV. Advances in genetics of juvenile myoclonic epilepsies. Epilepsy Curr. 2007 May-Jun. 7(3):61-7. [QxMD MEDLINE Link].
Wallace R. Identification of a new JME gene implicates reduced apoptotic neuronal death as a mechanism of epileptogenesis. Epilepsy Curr. 2005 Jan-Feb. 5(1):11-3. [QxMD MEDLINE Link].
Suzuki T, Delgado-Escueta AV, Aguan K, et al. Mutations in EFHC1 cause juvenile myoclonic epilepsy. Nat Genet. 2004 Aug. 36(8):842-9. [QxMD MEDLINE Link].
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. 2008 May 27. 70(22 Pt 2):2137-44. [QxMD MEDLINE Link].
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. 2008 Nov. 82(1):21-28. [QxMD MEDLINE Link]. [Full Text].
Tóth V, Rásonyi G, Fogarasi A, Kovács N, Auer T, Janszky J. Juvenile myoclonic epilepsy starting in the eighth decade. Epileptic Disord. 2007 Sep. 9(3):341-5. [QxMD MEDLINE Link].
Camfield CS, Camfield PR. Juvenile myoclonic epilepsy 25 years after seizure onset: a population-based study. Neurology. 2009 Sep 29. 73(13):1041-5. [QxMD MEDLINE Link].
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. 2009 Jun. 50(6):1525-35. [QxMD MEDLINE Link].
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. 2008 May 27. 70(22 Pt 2):2123-9. [QxMD MEDLINE Link].
Sadleir LG, Scheffer IE, Smith S, Carstensen B, Carlin J, Connolly MB, et al. Factors influencing clinical features of absence seizures. Epilepsia. 2008 Dec. 49(12):2100-7. [QxMD MEDLINE Link].
Badawy RA, Macdonell RA, Jackson GD, Berkovic SF. Why do seizures in generalized epilepsy often occur in the morning?. Neurology. 2009 Jul 21. 73(3):218-22. [QxMD MEDLINE Link].
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. 2008 Jul. 13(1):196-201. [QxMD MEDLINE Link].
Piazzini A, Turner K, Vignoli A, Canger R, Canevini MP. Frontal cognitive dysfunction in juvenile myoclonic epilepsy. Epilepsia. 2008 Apr. 49(4):657-62. [QxMD MEDLINE Link].
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. 2009 Mar. 14(3):516-21. [QxMD MEDLINE Link].
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. 2008 Apr. 49(4):663-9. [QxMD MEDLINE Link].
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. 2009 Jun. 50(6):1572-8. [QxMD MEDLINE Link].
Lu Y, Waltz S, Stenzel K, Muhle H, Stephani U. Photosensitivity in epileptic syndromes of childhood and adolescence. Epileptic Disord. 2008 Jun. 10(2):136-43. [QxMD MEDLINE Link].
Leutmezer F, Lurger S, Baumgartner C. Focal features in patients with idiopathic generalized epilepsy. Epilepsy Res. 2002 Aug. 50 (3):293-300. [QxMD MEDLINE Link].
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. 2007 Oct. 77(1):17-21. [QxMD MEDLINE Link].
Park KI, Lee SK, Chu K, Lee JJ, Kim DW, Nam H. The value of video-EEG monitoring to diagnose juvenile myoclonic epilepsy. Seizure. 2009 Mar. 18(2):94-9. [QxMD MEDLINE Link].
Stefan H, Paulini-Ruf A, Hopfengärtner R, Rampp S. Network characteristics of idiopathic generalized epilepsies in combined MEG/EEG. Epilepsy Res. 2009 Aug. 85(2-3):187-98. [QxMD MEDLINE Link].
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. 2009 Oct. 86(2-3):138-45. [QxMD MEDLINE Link].
Saini J, Sinha S, Bagepally BS, Ramchandraiah CT, Thennarasu K, Prasad C, et al. Subcortical structural abnormalities in juvenile myoclonic epilepsy (JME): MR volumetry and vertex based analysis. Seizure. 2013 Apr. 22(3):230-5. [QxMD MEDLINE Link].
Tae WS, Kim SH, Joo EY, Han SJ, Kim IY, Kim SI, et al. Cortical thickness abnormality in juvenile myoclonic epilepsy. J Neurol. 2008 Apr. 255(4):561-6. [QxMD MEDLINE Link].
Roebling R, Scheerer N, Uttner I, Gruber O, Kraft E, Lerche H. Evaluation of cognition, structural, and functional MRI in juvenile myoclonic epilepsy. Epilepsia. 2009 Jun 1. [QxMD MEDLINE Link].
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. 2007 Oct 1. 37(4):1132-7. [QxMD MEDLINE Link].
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. 2009 May. 50(5):1210-9. [QxMD MEDLINE Link].
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. 2009 May. 50(5):1201-9. [QxMD MEDLINE Link].
de Araujo Filho GM, de Araujo TB, Sato JR, Silva Id, Lin K, Júnior HC, et al. Personality traits in juvenile myoclonic epilepsy: evidence of cortical abnormalities from a surface morphometry study. Epilepsy Behav. 2013 May. 27(2):385-92. [QxMD MEDLINE Link].
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. 2008 Dec 9. 71(24):1981-5. [QxMD MEDLINE Link].
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. 2009 May. 50(5):1191-200. [QxMD MEDLINE Link].
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. 2009 Jun. 15(2):202-7. [QxMD MEDLINE Link].
[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. 2009 Sep. 50(9):2147-53. [QxMD MEDLINE Link].
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. 2009 Jul. 18(6):387-91. [QxMD MEDLINE Link].
Park KM, Kim SH, Nho SK, Shin KJ, Park J, Ha SY, et al. A randomized open-label observational study to compare the efficacy and tolerability between topiramate and valproate in juvenile myoclonic epilepsy. J Clin Neurosci. 2013 May 11. [QxMD MEDLINE Link].
Sullivan JE, Dlugos DJ. Idiopathic Generalized Epilepsy. Curr Treat Options Neurol. 2004 May. 6(3):231-242. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. 2008 Feb 19. 70(8):607-16. [QxMD MEDLINE Link].
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. 2009 Jul. 85(1):72-80. [QxMD MEDLINE Link].
Sharpe DV, Patel AD, Abou-Khalil B, Fenichel GM. Levetiracetam monotherapy in juvenile myoclonic epilepsy. Seizure. 2008 Jan. 17(1):64-8. [QxMD MEDLINE Link].
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. 2008 Jan. 50(1):29-32. [QxMD MEDLINE Link].
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. 2004 Aug. 5(4):509-12. [QxMD MEDLINE Link].
Wheless JW, Clarke DF, Arzimanoglou A, Carpenter D. Treatment of pediatric epilepsy: European expert opinion, 2007. Epileptic Disord. 2007 Dec. 9(4):353-412. [QxMD MEDLINE Link].
Prasad A, Kuzniecky RI, Knowlton RC, et al. Evolving antiepileptic drug treatment in juvenile myoclonic epilepsy. Arch Neurol. 2003 Aug. 60(8):1100-5. [QxMD MEDLINE Link].
Kothare SV, Valencia I, Khurana DS, et al. Efficacy and tolerability of zonisamide in juvenile myoclonic epilepsy. Epileptic Disord. 2004 Dec. 6(4):267-70. [QxMD MEDLINE Link].
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. 2004 Jan. 75(1):75-9. [QxMD MEDLINE Link].
The North American Antiepileptic Drug Pregnancy Registry. Available at http://www.aedpregnancyregistry.org/. Accessed: June 24, 2016.
UK Epilepsy and Pregnancy Register. Available at http://www.epilepsyandpregnancy.co.uk/. Accessed: June 24, 2016.
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. 2007 Dec. 39(6):354-60. [QxMD MEDLINE Link].
Wolf P, Yacubian EM, Avanzini G, Sander T, Schmitz B, Wandschneider B, et al. Juvenile myoclonic epilepsy: A system disorder of the brain. Epilepsy Res. 2015 Aug. 114:2-12. [QxMD MEDLINE Link].
Yacubian EM. Juvenile myoclonic epilepsy: Challenges on its 60th anniversary. Seizure. 2017 Jan. 44:48-52. [QxMD MEDLINE Link].
Pietrafusa N, La Neve A, de Palma L, Boero G, Luisi C, Vigevano F, et al. Juvenile myoclonic epilepsy: Long-term prognosis and risk factors. Brain Dev. 2021 Jun. 43 (6):688-697. [QxMD MEDLINE Link].
Benbadis SR. Practical management issues for idiopathic generalized epilepsies. Epilepsia. 2005. 46 Suppl 9:125-32. [QxMD MEDLINE Link].
Benbadis SR, Tatum WO 4th, Gieron M. Idiopathic generalized epilepsy and choice of antiepileptic drugs. Neurology. 2003 Dec 23. 61 (12):1793-5. [QxMD MEDLINE Link].
Baykan B, Wolf P. Juvenile myoclonic epilepsy as a spectrum disorder: A focused review. Seizure. 2017 Jul. 49:36-41. [QxMD MEDLINE Link].
Striano P, Nobile C. The genetic basis of juvenile myoclonic epilepsy. Lancet Neurol. 2018 Jun. 17 (6):493-495. [QxMD MEDLINE Link].
Koepp MJ, Woermann F, Savic I, Wandschneider B. Juvenile myoclonic epilepsy--neuroimaging findings. Epilepsy Behav. 2013 Jul. 28 Suppl 1:S40-4. [QxMD MEDLINE Link].
Hirsch E, French J, Scheffer IE, et al. ILAE Definition of the Idiopathic Generalized Epilepsy Syndromes: Position Statement by the ILAE Task Force on Nosology and Definitions. 2021 April. Available at https://www.ilae.org/files/dmfile/IGEFINALApril2.pdf.
Geithner J, Schneider F, Wang Z, Berneiser J, Herzer R, Kessler C, et al. Predictors for long-term seizure outcome in juvenile myoclonic epilepsy: 25-63 years of follow-up. Epilepsia. 2012 Aug. 53 (8):1379-86. [QxMD MEDLINE Link].
Höfler J, Unterberger I, Dobesberger J, Kuchukhidze G, Walser G, Trinka E. Seizure outcome in 175 patients with juvenile myoclonic epilepsy--a long-term observational study. Epilepsy Res. 2014 Dec. 108 (10):1817-24. [QxMD MEDLINE Link].
Ramos-Lizana J, Martínez-Espinosa G, Aguilera-López P, Aguirre-Rodriguez J. Probability of Remission of the Main Epileptic Syndromes in Childhood. J Child Neurol. 2022 Jan. 37 (1):89-97. [QxMD MEDLINE Link].
Lancman ME, Asconapé JJ, Penry JK. Clinical and EEG asymmetries in juvenile myoclonic epilepsy. Epilepsia. 1994 Mar-Apr. 35 (2):302-6. [QxMD MEDLINE Link].
French JA, Krauss GL, Wechsler RT, Wang XF, DiVentura B, Brandt C, et al. Perampanel for tonic-clonic seizures in idiopathic generalized epilepsy A randomized trial. Neurology. 2015 Sep 15. 85 (11):950-7. [QxMD MEDLINE Link].

Media Gallery

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.

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Author

Mona M Sonbol, MD Resident Physician, Department of Neurology, University of South Florida Morsani College of Medicine

Mona M Sonbol, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Neurological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

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, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Bioserenity, Ceribell, Eisai, Jazz, LivaNova, Neurelis, Neuropace, SK life science, Sunovion, Takeda, UCB<br/>Serve(d) as a speaker or a member of a speakers bureau for: Aquestive, Bioserenity, Eisai, Jazz, LivaNova, Neurelis, SK life science, Stratus, Sunovion, UCB<br/>Received research grant from: Cerevel Therapeutics, Ovid Therapeutics, Neuropace, Greenwich Jazz, SK Life Science, Xenon Pharmaceuticals, UCB, Marinus, Neuroelectrics Corporation, Longboard, Janssen, Equilibre Biopharmaceuticals.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Additional Contributors

Jose E Cavazos, MD, PhD, FAAN, FANA, FACNS, FAES Professor with Tenure, Departments of Neurology, Neuroscience, and Physiology, Assistant Dean for the MD/PhD Program, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio

Jose E Cavazos, MD, PhD, FAAN, FANA, FACNS, FAES is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Neurological Association, Society for Neuroscience

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Brain Sentinel, consultant.<br/>Stakeholder (<5%), Co-founder for: Brain Sentinel.

Ramon Diaz-Arrastia, MD, PhD Professor, Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director, North Texas TBI Research Center, Comprehensive Epilepsy Center, Parkland Memorial Hospital

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Souvik Sen, MD, MPH, MS, FAHA Professor and Chair, Department of Neurology, University of South Carolina School of Medicine

Souvik Sen, MD, MPH, MS, FAHA is a member of the following medical societies: American Academy of Neurology, Association for Patient-Oriented Research, American Heart Association

Disclosure: Nothing to disclose.

Elizabeth Carroll, DO Resident Physician, Department of Neurology, University of South Florida College of Medicine

Elizabeth Carroll, DO is a member of the following medical societies: American Academy of Neurology, American Osteopathic Association, Florida Osteopathic Medical Association

Disclosure: Nothing to disclose.

James Selph, MD Assistant Professor of Neurology, University of South Carolina School of Medicine; Director of Neurophysiology Lab and Services, Palmetto Richland Hospital

James Selph, MD is a member of the following medical societies: American Association of Neuromuscular and Electrodiagnostic Medicine, American Epilepsy Society

Disclosure: Nothing to disclose.

Acknowledgements

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; ucb Honoraria Speaking and teaching; lumdbeck Honoraria Consulting