Of 31 patients with juvenile myoclonic epilepsy (JME), 21 (67.7%) became seizure-free after a follow-up of at least 25 years, according to a study published in the June 12 online Epilepsia. Six seizure-free patients (28.6%) were able to discontinue treatment with AEDs and remained seizure-free for a mean duration of 19.2 years.
Generalized tonic–clonic seizures (GTCS) preceded by bilateral myoclonic seizures were significantly associated with a low likelihood of becoming seizure-free, said Julia Geithner of the Epilepsy Center at the University of Greifswald in Germany. Seizure-free patients with photoparoxysmal response were likely to experience a recurrence of seizures after withdrawing from AEDs. AED polytherapy and long duration of epilepsy with unsuccessful treatment were associated with poor long-term seizure outcomes. Complete remission of GTCS during AED therapy, however, significantly increased patients’ chance of complete seizure freedom.
Ms. Geithner and her colleagues reviewed data from 31 patients with JME. Of these participants, 19 were women, and the population’s mean age was 52.2. Patients had normal neurologic exams and were followed up for at least 25 years. The mean age of epilepsy onset was 13.1, and the mean follow-up was 39.1 years.
“Our findings of long-term seizure freedom and the statistical validation of several outcome predictors can potentially increase the clinicians’ ability and confidence to recommend different treatment options to patients with JME,” said Ms. Geithner. “In contrast to the current opinion, lifelong AED treatment is shown to be not necessarily required to maintain seizure freedom in these patients, and the decision should depend on several predictors identified in our study,” she concluded.
Geithner J, Schneider F, Wang Z, et al. Predictors for long-term seizure outcome in juvenile myoclonic epilepsy: 25-63 years of follow-up. Epilepsia. 2012 Jun 12; [Epub ahead of print].