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Trait impulsivity in Juvenile Myoclonic Epilepsy

Lookup NU author(s): Dr Rhys ThomasORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.OBJECTIVE: Impulsivity is a multidimensional construct that can predispose to psychopathology. Meta-analysis demonstrates an association between response impulsivity and Juvenile Myoclonic Epilepsy (JME), a common genetic generalized epilepsy. Here, we test the hypotheses that trait impulsivity is (i) elevated in JME compared to controls; (ii) moderated by specific seizure characteristics; and (iii) associated with psychiatric adverse effects of antiepileptic drugs (AEDs). METHODS: 322 participants with JME and 126 age and gender-matched controls completed the Barratt's Impulsiveness Scale (BIS-brief) alongside information on seizure history and AED use. We compared group BIS-brief scores and assessed associations of JME BIS-brief scores with seizure characteristics and AED adverse effects. RESULTS: The mean BIS-brief score in JME was 18.1 ± 4.4 compared with 16.2 ± 4.1 in controls (P = 0.0007). Elevated impulsivity was associated with male gender (P = 0.027), frequent absence seizures (P = 0.0004) and lack of morning predominance of myoclonus (P = 0.008). High impulsivity significantly increased the odds of a psychiatric adverse event on levetiracetam (P = 0.036), but not any other psychiatric or somatic adverse effects. INTERPRETATION: Trait impulsivity is elevated in JME and comparable to scores in personality and neurotic disorders. Increased seizure frequency and absence of circadian seizure pattern moderate BIS score, suggesting disruption of both cortico-striatal and thalamocortical networks as a shared mechanism between seizures and impulsivity in JME. These findings warrant consideration of impulsivity as a distinct target of intervention, and as a stratifying factor for AED treatment in JME, and perhaps other types of epilepsy. The role of impulsivity in treatment adherence and psychosocial outcome requires further investigation.

Publication metadata

Author(s): Shakeshaft A, Panjwani N, McDowall R, Crudgington H, Pena Ceballos J, Andrade DM, Beier CP, Fong CY, Gesche J, Greenberg DA, Hamandi K, Koht J, Lim KS, Orsini A, Rees MI, Rubboli G, Selmer KK, Smith AB, Striano P, Syvertsen M, Talvik I, Thomas RH, Zarubova J, Richardson MP, Strug LJ, Pal DK

Publication type: Article

Publication status: Published

Journal: Annals of Clinical and Translational Neurology

Year: 2021

Volume: 8

Issue: 1

Pages: 138-152

Print publication date: 01/01/2021

Online publication date: 02/12/2020

Acceptance date: 03/11/2020

Date deposited: 31/03/2021

ISSN (electronic): 2328-9503

Publisher: John Wiley & Sons, Ltd.


DOI: 10.1002/acn3.51255

PubMed id: 33264519


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Funder referenceFunder name
Charles Sykes Epilepsy Research Trust
BioMarin Pharmaceutical
Engineering and Physical Sciences Research Council. Grant Number: EP/N014391/1
Canadian Institutes of Health Research. Grant Numbers: 201503MOP‐342469, 201809FDN‐407295
Epilepsy Research UK
GW Pharmaceuticals / Abertawe Bro Morgannwg University NHS R&D / Kolfarma / Eisai
Health and Care Research Wales
Medical Research Council. Grant Numbers: MR/K013998/1, MR/N026063/1
Nationwide Children's Hospital / DINOGMI Department of Excellence of MIUR
Norges Forskningsråd. Grant Number: 299266
Odense Universitetshospital
NIHR Specialist Biomedical Research Centre for Mental Health of South London and Maudsley National Health Service Foundation Trust
Seventh Framework Programme. Grant Number: 602531
South‐Eastern Regional Health Authority, Norway. Grant Number: 2016129
Syddansk Universitet. Grant Number: 17/18517
Wales Gene Park
Waterloo Foundation. Grant Number: 164‐3020