We appreciate the comments of Grunewald and colleagues. In their insightful remarks, they attempt to crystallize the present status of AEDs in the treatment of JME. They recommend separating seizure-free patients from those with infrequent seizures (<1 generalized tonic-clonic seizure a year or <5 single or cluster myoclonic seizures per month). In our study, these 2 groups of patients were combined and defined as patients with a good outcome. We thoroughly agree that the only wholly satisfactory outcome for any patient is complete seizure freedom. However, a lesser standard is commonly used in clinical trials to allow the measurement of a drug’s effect in groups of satisfactory size for statistical analysis, such as the frequently used 50% seizure reduction rate. We included patients with rare seizures in the good-outcome group not because we believe that this is the ideal but to analyze significant but incomplete drug effects as well as completely successful effects. Furthermore, in patients with JME, complete freedom from myoclonic jerks is often difficult to determine from the history, making it hard to quantify a group as completely seizure-free.
Prasad A, Kuzniecky RI, Knowlton RC, et al. Evolving Antiepileptic Drug Treatment in Juvenile Myoclonic Epilepsy—Reply. Arch Neurol. 2004;61(8):1328–1329. doi:10.1001/archneur.61.8.1328-b
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