title: Clinical heterogeneity of juvenile myoclonic epilepsy: follow-up after an interval of more than 20 years.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Neurology, Drammen Hospital, Drammen, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Marte R
authors: MR
authors: Syvertsen
authors: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Selma
authors: S
authors: Thuve
authors: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Benedicte S
authors: BS
authors: Stordrange
authors: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway. Electronic address: eylert.brodtkorb@ntnu.no.
authors: Eylert
authors: E
authors: Brodtkorb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020190:Myoclonic Epilepsy, Juvenile / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D011379:Prognosis; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D013997:Time Factors
chemical_list: D000927:Anticonvulsants
keywords: Juvenile myoclonic epilepsy; Long-term follow-up; Psychosocial outcome; Seizure outcome