Antiseizure Medications Withdrawal Seizures in Patients with Juvenile Myoclonic Epilepsy.

BACKGROUND: Patients with juvenile myoclonic epilepsy (JME) are especially prone to having antiseizure medications (ASMs) withdrawal seizures (WS). OBJECTIVES: To clarify whether WS in JME patients are caused by a high tendency of non-adherence from seizure-free patients or by a constitutive increased sensitivity to drug withdrawal. METHODS: Epilepsy patients followed in a tertiary epilepsy clinic between 2010 and 2013 were included in the study. WS prevalence was compared between drug-responsive and drug-resistant JME patients and patients with other types of epilepsy. RESULTS: The study included 23 JME patients (16 drug-responsive and 7 drug-resistant) and 138 patients with other epilepsies (74 drug-responsive and 64 drug-resistant). JME patients were younger and included more women than non-JME patients. Significantly more WS were seen in JME than in non-JME patients (P = 0.01) and in the drug-resistant fraction of JME patients in comparison to drug-resistant non-JME patients (P = 0.02). On logistic regression, the type of epilepsy, but not the patient's sex, was found to significantly predict WS. No significant difference was found in the prevalence of WS between drug-responsive and drug-resistant JME patients. The main ASM discontinued in JME was valproic acid (VPA), especially in women. CONCLUSIONS: Our findings suggest a higher sensitivity of JME patients to withdrawal of medications. It is important to educate JME patients about treatment adherence and to explain to their physicians how to carefully reduce or replace ASMs to mitigate the morbidity and mortality related to ASM withdrawal.

Low serum potassium levels are associated with the risk of atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. AF is associated with approximately a threefold to fivefold increased risk for stroke. Hypokalaemia is associated with ventricular arrhythmias and cardiac arrest. Little is known about the association of serum potassium with atrial fibrillation. AIMS: The aims of this study are to assess the association of low serum potassium (hypokalaemia) and the risk of AF. METHODS: Retrospective data were collected for all patients' records, who were hospitalised at department of Internal Medicine of Ziv Medical Centre, Safed, Israel, from January 2013 to December 2017 with AF. Clinical data were obtained from patient's hospital records. We excluded those who were pregnant, diagnosed with malignancy and those with thyrotoxicosis. Control group consisted of patients who were hospitalised in the same period with normal sinus rhythm (NSR). We compared between the two groups in term of age, gender, comorbidities and serum levels of potassium and magnesium. RESULTS: We enrolled 281 subjects with AF who responded to our study purposes. The control group consistend of 260 with NSR. Hypokalaemia of less than 3.5 mmol/l was found in 16% in the study group vs. 8.4% in control group, p = 0.001. Multivariate regression analysis showed that OR 2.08, 95% CI (1.378-3.138), p = 0.01, and hypokalaemia < 3.5 mmol/l OR1.827, 95%CI (1.50-3.179), p = 0.02 were found to be associated with atrial fibrillation. CONCLUSION: We found that low serum potassium levels of less than 3.5 mmol/l are associted with increased risk of AF.