Avirup Chowdhury1, Martin J Brodie2. 1. Epilepsy Unit, Western Infirmary, Glasgow G11 6NT, Scotland, UK. 2. Epilepsy Unit, Western Infirmary, Glasgow G11 6NT, Scotland, UK. Electronic address: Martin.Brodie@glasgow.ac.uk.
Abstract
PURPOSE: Juvenile myoclonic epilepsy (JME) is one of the most frequently diagnosed of the idiopathic generalised epilepsy syndromes, but long term outcome data still remain sparse. METHODS: A retrospective audit was undertaken in 186 patients (male: n=78; female: n=108) diagnosed with JME at the Epilepsy Unit at the Western Infirmary in Glasgow, Scotland between July 1981 and July 2012. Median age at treatment start was 16 years (range 13-44), with median follow-up of 14 years (range 2-32). RESULTS: Overall, 171 patients (92%) achieved remission with antiepileptic drug (AED) treatment (median 9.5 years; range 1-31). After discontinuing treatment in 28 patients, only 11 remained seizure-free off medication. Fifteen patients (8%) continued to have seizures despite having tried up to 8 AED regimens: (5 male, 10 female), 7 of whom had psychiatric comorbidities. AEDs most commonly prescribed included sodium valproate (VPA; n=142), lamotrigine (LTG; n=66) and levetiracetam (LEV; n=22). More male patients than female attained remission with their first or second AED schedule (88% versus 56%). More male patients (44%) received VPA than female (31%) overall. Fewer male patients than female received LTG (26% versus 74%) and LEV (22% versus 78%). Of the monotherapies, remission was achieved using VPA (n=74; 52%), LTG (n=21; 32%) and LEV (n=12, 55%). A total of 76 (25%) of AED schedules resulted in intolerable side-effects, including 29 with VPA, 12 with LTG and 4 with LEV. CONCLUSION: Overall, JME showed a high rate of seizure freedom with AED treatment. VPA appeared to be the most effective AED. Women tended to have a worse outcome than men, since they were increasingly less likely to receive VPA. Patients with psychiatric comorbidities also had a poorer prognosis.
PURPOSE:Juvenile myoclonic epilepsy (JME) is one of the most frequently diagnosed of the idiopathic generalised epilepsy syndromes, but long term outcome data still remain sparse. METHODS: A retrospective audit was undertaken in 186 patients (male: n=78; female: n=108) diagnosed with JME at the Epilepsy Unit at the Western Infirmary in Glasgow, Scotland between July 1981 and July 2012. Median age at treatment start was 16 years (range 13-44), with median follow-up of 14 years (range 2-32). RESULTS: Overall, 171 patients (92%) achieved remission with antiepileptic drug (AED) treatment (median 9.5 years; range 1-31). After discontinuing treatment in 28 patients, only 11 remained seizure-free off medication. Fifteen patients (8%) continued to have seizures despite having tried up to 8 AED regimens: (5 male, 10 female), 7 of whom had psychiatric comorbidities. AEDs most commonly prescribed included sodium valproate (VPA; n=142), lamotrigine (LTG; n=66) and levetiracetam (LEV; n=22). More male patients than female attained remission with their first or second AED schedule (88% versus 56%). More male patients (44%) received VPA than female (31%) overall. Fewer male patients than female received LTG (26% versus 74%) and LEV (22% versus 78%). Of the monotherapies, remission was achieved using VPA (n=74; 52%), LTG (n=21; 32%) and LEV (n=12, 55%). A total of 76 (25%) of AED schedules resulted in intolerable side-effects, including 29 with VPA, 12 with LTG and 4 with LEV. CONCLUSION: Overall, JME showed a high rate of seizure freedom with AED treatment. VPA appeared to be the most effective AED. Women tended to have a worse outcome than men, since they were increasingly less likely to receive VPA. Patients with psychiatric comorbidities also had a poorer prognosis.
Authors: Katri Silvennoinen; Nikola de Lange; Sara Zagaglia; Simona Balestrini; Ganna Androsova; Merel Wassenaar; Pauls Auce; Andreja Avbersek; Felicitas Becker; Bianca Berghuis; Ellen Campbell; Antonietta Coppola; Ben Francis; Stefan Wolking; Gianpiero L Cavalleri; John Craig; Norman Delanty; Michael R Johnson; Bobby P C Koeleman; Wolfram S Kunz; Holger Lerche; Anthony G Marson; Terence J O'Brien; Josemir W Sander; Graeme J Sills; Pasquale Striano; Federico Zara; Job van der Palen; Roland Krause; Chantal Depondt; Sanjay M Sisodiya Journal: Epilepsia Open Date: 2019-07-04