Do you use alcohol to trigger seizures in patients you suspect to have JME to confirm diagnosis?

In the EMU, I use ETOH as a seizure trigger, if the patient tells me drinking alcohol makes them have a seizure or they have one the next day. I do this regardless of their epilepsy syndrome, not specifically for JME.

I would agree that EMU monitoring and seizure provocation should not be necessary in a patient with JME. Many patients with genetic generalized/generalized spike-wave trait on EEG may have concomitant or exclusively non-epileptic events. these are the only patients with a characteristic interictal EEG that benefit from diagnostic EMU admission. In these cases, provoking a generalized convulsion with alcohol only muddies the waters.

In very select patients with focal epilepsy, alcohol may be a strong trigger and only in those cases do I ever consider provocation with alcohol. In our epilepsy monitoring unit, alcohol provocation is used less than once per year across three epileptologists. Patients should be screened for a history of alcohol ...

JME is a clinical diagnosis that can be ascertained via thorough history in combination with an EEG demonstrating characteristic interictal findings irrespective of alcohol induction. A recent investigation by Emmert et al., PMID 38070406 into the utility of alcohol as an activating procedure during diagnostic EMU evaluations has revealed that its usefulness is overstated and no more likely than controls to elicit paroxysmal events of any kind.