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Clinical heterogeneity of juvenile myoclonic epilepsy: follow-up after an interval of more than 20 years - PubMed

Clinical heterogeneity of juvenile myoclonic epilepsy: follow-up after an interval of more than 20 years

Marte R Syvertsen et al. Seizure. 2014 May.

Free article

Abstract

Purpose: The view that juvenile myoclonic epilepsy (JME) is a uniform and life-long disorder is currently being challenged. The aim of this study was to assess the seizure and psychosocial outcome of JME at least 20 years after onset.

Methods: In 1992, 42 patients with JME were identified. In 2012, 37 agreed to a semi-structured interview. In the remaining five, only medical records were available.

Results: Of 40 patients with known seizure outcome, 21 were in remission for >5 years. Seven were off antiepileptic drugs (AEDs), four being seizure free for >10 years. Myoclonic seizures (MC) evolving to generalized tonic-clonic seizures (GTC) were associated with seizure persistence (p=0.013), whereas >1 year between MC and GTC onset was associated with a trend to GTC remission (p=0.069). Of 19 patients with uncontrolled seizures, eight experienced remission with second generation AEDs. Favorable psychosocial outcome by interview was found in a third, whereas another third had psychiatric comorbidity, seven with substance or alcohol abuse. Psychosocial and seizure outcome did not correlate.

Conclusion: This study corroborates the heterogeneity of JME in terms of seizure and psychosocial outcome, but without a clear association between the two. It confirms that seizure control may persist after AED withdrawal in some and supports MC evolving to GTC as a predictor of seizure persistence. Moreover, it suggests that newer broad spectrum AEDs may improve the prognosis of JME; their impact should be focus of prospective studies.

Keywords: Juvenile myoclonic epilepsy; Long-term follow-up; Psychosocial outcome; Seizure outcome.

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Clinical heterogeneity of juvenile myoclonic epilepsy: follow-up after an interval of more than 20 years - PubMed