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Juvenile myoclonic epilepsy (JME) is generally thought to respond well to first line treatment but many patients continue to suffer with seizure activity. This study reviews JME patients managed in a tertiary epilepsy centre.A JME patient cohort with data on medication and seizure frequency was sourced from an epilepsy database at University Hospital of Wales, Cardiff.168 patients (18–84 years old) were identified with a diagnosis of JME and a clinic appointment in the past 5 years. There was a female predominance of 2.8:1. The average age at onset was 13.56% patients were free of generalised tonic-clonic seizures with 40% free of all seizure types. Of those with frequent seizure activity, 66% were on at least 2 anti-epileptic drugs (AEDs). Levetiracetam was the most common therapy (48%). 32 women of childbearing age (32%) were taking Valproate with 71% under regular follow-up.Whilst JME is considered to respond well to AEDs a significant proportion in our tertiary cohort were deemed drug refractory. However, this may show bias when compared to community samples. The number of women taking Valproate highlights the benefit of the drug and the need for careful monitoring and shared clinical decision making.