title: Seizure outcome in 175 patients with juvenile myoclonic epilepsy--a long-term observational study.
abstract: BACKGROUND
  Juvenile myoclonic epilepsy (JME) is a genetic generalized epilepsy syndrome. Under appropriate antiepileptic drugs (AED) up to 85% of patients become seizure-free, but many may have a relapse after AED withdrawal.
  
  
  METHODS
  We retrospectively studied 242 patients with JME at the Department of Neurology, Medical University Innsbruck, Austria (1975-2006). We analyzed age at seizure onset, age at last follow up, seizure types, photosensitivity, seizure outcome and neuroimaging findings; inclusion criterion was a medical treatment period of >2 years; exclusion criteria were traumatic or infectious brain injury before the onset of JME and/or gross structural pathology on neuroimaging.
  
  
  RESULTS
  We identified 175 patients (111 women) with a median age at seizure onset of 15 years, (range 3-46) and a median age at follow-up (FU) of 38 years (range 14-87; median FU 8 years, range 2-38). Fourteen percent showed (24/175) photosensitivity on routine EEG. Seizure outcome: 62% (109/175) were seizure-free of myoclonic seizures (MS), generalized tonic clonic seizures (GTCS) and absence seizures (AS) for >1 year, and 53% (94/175) for >2 years, including 16 patients (9%) without AEDs. Thirty-one percent (54/175) were seizure-free between 2 and 5 years, 15% (26/175) between 6 and 10, and 8% (14/175) >10 years; 38% (66/175) were not seizure-free. Not seizure-free patients had more often MS, AS and GTCS within the first year of epilepsy than those who were seizure-free at last FU (11% vs. 3%, Chi(2)=4.679, df=1, p=0.043). Seizure-free patients had more often MS and GTCS as last seizure types in the year before becoming seizure-free (37% vs. 15%, p=0.003), whereas in not seizure-free group MS only and GTCS only persisted.
  
  
  CONCLUSIONS
  JME does not always need lifelong treatment, as a substantial minority of patients remain seizure-free without AEDs. AS, MS and GTCS at onset of the disease are indicators of poor long-term seizure control.
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria; Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Höfler
authors.affiliation: Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Iris
authors.initials: I
authors.lastname: Unterberger
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria; Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Judith
authors.initials: J
authors.lastname: Dobesberger
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria; Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Kuchukhidze
authors.affiliation: Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Walser
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria; Department of Neurology, Innsbruck Medical University, Innsbruck, Austria. Electronic address: E.Trinka@salk.at.
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020190:Myoclonic Epilepsy, Juvenile / Q000188:drug therapy* / Q000503:physiopathology*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Generalized epilepsy; Juvenile myoclonic epilepsy; Prognosis; Seizure-freedom