We thank Finsterer and colleagues [1] for their comments on our proposal for a therapeutic strategy in patients with Progressive Myoclonus Epilepsy (PME) [2]. We agree that valproic acid (VPA) should not be recommended as a first-line anti-seizure drug in myoclonic epilepsies secondary to mitochondrial disorders (MIDs), as universally accepted in the Literature [3–6]. In patients with suspected MID, we propose levetiracetam and/or benzodiazepines as first-line treatment whereas lamotrigine, perampanel, topiramate, and zonisamide should be considered as potential alternatives (Fig.
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