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.

2nd Faculty of Medicine Charles University Prague Czech Republic

Cardiff and Vale University Health Board UK

Danish Epilepsy Centre Dianalund Denmark

Department of Basic and Clinical Neurosciences Institute of Psychiatry Psychology and Neuroscience King's College London UK

Department of Clinical and Experimental Medicine Pisa University Hospital Italy

Department of Neurology Drammen Hospital Vestre Viken Health Trust Oslo Norway

Department of Neurology Motol University Hospital Prague Czech Republic

Department of Research and Innovation Division of Clinical Neuroscience Oslo University Hospital Norway

Division of Neurology Department of Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia

Division of Paediatric Neurology Department of Paediatrics Faculty of Medicine University of Malaya Kuala Lumpur Malaysia

Evelina London Children's Hospital London UK

IRCCS Istituto 'G Gaslini' Genova Italy

King's College Hospital London UK

MRC Centre for Neurodevelopmental Disorders King's College London UK

National Centre for Epilepsy Oslo University Hospital Norway

Nationwide Children's Hospital Ohio

Neurology Research Group Swansea University Medical School UK

Newcastle upon Tyne NHS Foundation Trust Newcastle UK

Odense University Hospital Odense Denmark

Tallin Children's Hospital Tallin Estonia

The Hospital for Sick Children Toronto Canada

Toronto Western Hospital Canada

University of Copenhagen Denmark

University of Genova Genova Italy

University of Oslo Oslo Norway

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