JUVENILE MYOCLONIC EPILEPSY (JME)

	Mandatory	Alerts	Exclusionary
Seizures	Myoclonic seizures	Generalised tonic-clonic status epilepticus Consistent focal features at seizure onset	Myoclonic absence, atonic, tonic, atypical absence or focal seizures Myoclonic seizures predominantly/exclusively from sleep Myoclonic seizures exclusively with reading Cortical tremor with myoclonus
EEG	3-5.5Hz generalized spike- or poly-spike wave		Myoclonic event captured on EEG without spike- or poly-spike wave discharge Focal slowing or consistently focal epileptiform abnormality Generalised slow (<2.5Hz) spike-wave (measured at the beginning of a spike-wave discharge) Diffuse background slowing
Age at onset		8-9 or 25-40 years	<8 or >40 years
Development at onset		Mild intellectual impairment	Moderate or greater intellectual impairment
Neurological exam		Abnormal exam
Imaging		Abnormal, potentially relevant
Course of illness			Progressive cognitive decline Progressive myoclonic seizures with impaired fine motor function
Are MRI or ictal EEG required for diagnosis? An MRI is not required for diagnosis An ictal EEG is not required
Syndrome without laboratory confirmation: in resource-limited regions, this syndrome can be diagnosed in patients without alerts who meet all other mandatory and exclusionary criteria

NOTE Alert criteria are absent in the vast majority of patients with the syndrome, but rarely can be seen. Their presence should result in caution in diagnosing the syndrome and consideration of other conditions