Myoclonic epilepsy is being increasingly recognized as a late onset complication in middle-aged or elderly patients with Down syndrome, in association with acute cognitive decline or dementia. We report a case of late onset myoclonic epilepsy in Down syndrome (LOMEDS) with acute cognitive decline, aged 45 year-olds. Although her intelligence condition remained poor with one to two-words sentences and difficult in following commands even after treatment, induction of levetiracetam and lamotorigin resulted in rapid, sustained seizure freedom and upgrading social activity with no adverse events. A combination of levetiracetam and lamotorigin appear to be effective for LOMEDS, and could be considered as first line agents for this special condition.
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