Antiseizure Treatment for Epilepsy with Myoclonic Atonic Seizures at Later Stages of Management
Epilepsy with myoclonic atonic seizures is characterised by seizures that combine myoclonic and atonic components. When initial treatment strategies prove insufficient, a specific set of later-stage antiseizure medication options is considered to achieve meaningful seizure control.
At later stages, treatment involves certain antiseizure medication combinations and add-on agents. The options include both combination regimens and adjunctive therapies — the specific selection, sequencing, and clinical considerations are set out in the full structured protocol.
The primary clinical targets are a 50% or greater reduction in seizure frequency, with complete seizure freedom as the optimal outcome.
- The combination of lamotrigine with valproate and benzodiazepine might reduce generalised seizures; however, lamotrigine can worsen myoclonus and carries the risk of Stevens-Johnson syndrome.
- Other treatments, such as cannabidiol, topiramate, zonisamide, felbamate, and sulthiame are based on anecdotal evidence and can be considered at later stages of treatment.
- A small case series reported that four of six patients with intractable epilepsy with myoclonic-atonic seizures became seizure free on felbamate.
- Another retrospective open-label study of 22 patients with epilepsy with myoclonic-atonic seizures who were resistant to most antiseizure medications and non-pharmacological treatments found that add-on purified cannabidiol led to a 50% or greater reduction in seizures in most patients, improving myoclonic-atonic, generalised tonic-clonic, and atypical absence seizures and non-convulsive status epilepticus.