Juvenile myoclonic epilepsy: Challenges on its 60th anniversary Elza Márcia Yacubian  Seizure - European Journal of Epilepsy  Volume 44, Pages 48-52 (January 2017) DOI: 10.1016/j.seizure.2016.09.005 Copyright © 2016 British Epilepsy Association Terms and Conditions

Fig. 1 Course of juvenile myoclonic epilepsy. Regarding seizure types, in most cases myoclonia precede generalized tonic-clonic seizures, although seizure expression can varied from pure myoclonia to the three seizure types. Percentages are from the original Janz and Christian series [3] (a) and Panayotopoulos et al. [12] (b). The four subsyndromes according to Martínez-Juárez et al. [18] (c). CAE: childhood absence epilepsy; JAE: juvenile absence epilepsy; JME: juvenile myoclonic epilepsy. Seizure - European Journal of Epilepsy 2017 44, 48-52DOI: (10.1016/j.seizure.2016.09.005) Copyright © 2016 British Epilepsy Association Terms and Conditions

Fig. 2 Percentages of the four reflex traits in juvenile myoclonic epilepsy [8,13–17]. Seizure - European Journal of Epilepsy 2017 44, 48-52DOI: (10.1016/j.seizure.2016.09.005) Copyright © 2016 British Epilepsy Association Terms and Conditions

Fig. 3 Effects of psychotherapy in a series of 58 adolescents and young adults with juvenile myoclonic epilepsy. Fifty percent of 14 patients resistant to pharmacotherapy and supportive counseling aiming at the elimination of seizure precipitants became seizure free in a six months follow-up [35]. Seizure - European Journal of Epilepsy 2017 44, 48-52DOI: (10.1016/j.seizure.2016.09.005) Copyright © 2016 British Epilepsy Association Terms and Conditions

Fig. 4 Prognosis in juvenile myoclonic epilepsy. While most of the patients reach seizure control, a third continue presenting seizures either due to true resistance to pharmacotherapy or pseudoresistance related to inadequate lifestyle, to low compliance, or to an inadequate choice of antiepileptic medications. Percentages are from Gelisse et al. [21] (d). Seizure - European Journal of Epilepsy 2017 44, 48-52DOI: (10.1016/j.seizure.2016.09.005) Copyright © 2016 British Epilepsy Association Terms and Conditions