Enhanced response inhibition in patients with drug‐resistant juvenile myoclonic epilepsy: Event‐related potentials evidence of excitatory–inhibitory imbalance

To investigate the excitatory-inhibitory imbalance in drug-resistant Juvenile Myoclonic Epilepsy (DR-JME) patients using event-related potentials during motor and cognitive tasks. Eighteen JME patients and 11 healthy controls performed a visual Go No-Go task while sitting (single-task) and walking (dual-task). EEG signals were analyzed using frequency-domain techniques. Nonparametric tests compared groups and conditions. JME patients showed worse performance and slower reaction times than healthy controls (p < 0.04). DR-JME patients demonstrated worse performance during Go cues (p = 0.001) but better withdrawal response to No-Go cues (p = 0.03) compared to drug-respondent JME. Significant differences in EEG spectral power were observed, particularly during dual-task conditions. JME patients had lower power in the delta and alpha frequency bands compared to controls (p < 0.03). DR-JME patients showed lower power in theta, alpha, and beta bands during dual-task Go cues (p < 0.003) but higher power during dual-task No-Go cues compared to drug-respondent JME (p < 0.02). DR-JME patients exhibited enhanced response inhibition, especially under dual-task conditions, which likely indicates maladaptive neural processing and supports the notion of an excitatory-inhibitory imbalance in DR-JME. This study provides new insights into the neurophysiological basis of drug resistance in JME, revealing distinct patterns of brain activity associated with inhibitory control. These findings could provide valuable insights into understanding the complex interactions between neuronal excitation and inhibition. Some patients with Juvenile Myoclonic Epilepsy (JME) do not respond to medication, but the reasons remain unclear. This study found that drug-resistant JME patients show distinct brain activity and behavioral patterns, particularly during tasks requiring attention and movement. They had slower reactions but showed better inhibition to stop responses, along with altered brain rhythms, especially under dual-task conditions. These results suggest an imbalance between brain excitation and inhibition, offering new insights into the neural mechanisms behind drug resistance in JME.