A Significant Proportion of Patients With Juvenile Myoclonic Epilepsy May Be Able to Remain Seizure-Free

In a retrospective cohort study analyzing seizure outcome in 66 patients with juvenile myoclonic epilepsy (JME) followed for a mean of nearly 45 years, investigators in Berlin, Germany, found that seizure remission occurred in 59.1% of patients, with 16.7% of all patients remaining seizure-free off antiepileptic drugs (AEDs) for at least five years before the last study contact. The results of the study, published in the December 10, 2013, issue of Neurology, suggest that treatment response and long-term remission in JME are more favorable than previously thought possible.

In addition, in identifying occurrence of absence seizures at the onset of JME as a significant predictor for poor outcome, the study points to a potentially different JME subtype—one that is indicative of a worse outcome.

Among its main findings, the study showed that, of the 39 patients who had a five-year terminal remission, 28 (71.8%) were still taking AEDs and 11 (28.2%) had been completely off medication for at least the past five years. Of the clinical variables assessed as potential predictors of seizure outcome in patients with (n = 39) and without (n = 27) remission, only additional manifestation of absence seizures at onset of JME was significantly associated with lack of five-year terminal remission.

The investigators also found, among all patients with remission, a significantly younger age at last seizure in patients who had achieved remission without AED therapy (mean age, 29.3 ± 9.3 years) versus those who had achieved remission and were currently receiving AED therapy—ie, patients with “controlled epilepsy” (39.8 ± 15 years).

Encompassing the largest cohort and longest follow-up period examining evolution of seizures in JME, as far as its authors could determine, this study demonstrated that seizures could be controlled in the majority of cases, with a significant proportion of patients off AED therapy—supporting, as lead author Philine Senf, MD, wrote, “the results of previous work showing that lifelong treatment in patients with JME may no longer apply as a general prognostic guideline.”

In an accompanying commentary, Norman K. So, MB, of the Cleveland Clinic, observed that “a proportion [of JME] remains resistant to treatment despite the advent of more and newer drugs” and that “Predictors of seizure persistence have been hard to come by,” suggesting that the identification of additional absence seizures as a predictor of unfavorable outcome is an important aspect of the “reappraisal” of JME that this study provides.

—Fred Balzac

In a retrospective cohort study analyzing seizure outcome in 66 patients with juvenile myoclonic epilepsy (JME) followed for a mean of nearly 45 years, investigators in Berlin, Germany, found that seizure remission occurred in 59.1% of patients, with 16.7% of all patients remaining seizure-free off antiepileptic drugs (AEDs) for at least five years before the last study contact. The results of the study, published in the December 10, 2013, issue of Neurology, suggest that treatment response and long-term remission in JME are more favorable than previously thought possible.

In addition, in identifying occurrence of absence seizures at the onset of JME as a significant predictor for poor outcome, the study points to a potentially different JME subtype—one that is indicative of a worse outcome.

Among its main findings, the study showed that, of the 39 patients who had a five-year terminal remission, 28 (71.8%) were still taking AEDs and 11 (28.2%) had been completely off medication for at least the past five years. Of the clinical variables assessed as potential predictors of seizure outcome in patients with (n = 39) and without (n = 27) remission, only additional manifestation of absence seizures at onset of JME was significantly associated with lack of five-year terminal remission.

The investigators also found, among all patients with remission, a significantly younger age at last seizure in patients who had achieved remission without AED therapy (mean age, 29.3 ± 9.3 years) versus those who had achieved remission and were currently receiving AED therapy—ie, patients with “controlled epilepsy” (39.8 ± 15 years).

Encompassing the largest cohort and longest follow-up period examining evolution of seizures in JME, as far as its authors could determine, this study demonstrated that seizures could be controlled in the majority of cases, with a significant proportion of patients off AED therapy—supporting, as lead author Philine Senf, MD, wrote, “the results of previous work showing that lifelong treatment in patients with JME may no longer apply as a general prognostic guideline.”

In an accompanying commentary, Norman K. So, MB, of the Cleveland Clinic, observed that “a proportion [of JME] remains resistant to treatment despite the advent of more and newer drugs” and that “Predictors of seizure persistence have been hard to come by,” suggesting that the identification of additional absence seizures as a predictor of unfavorable outcome is an important aspect of the “reappraisal” of JME that this study provides.

—Fred Balzac

In a retrospective cohort study analyzing seizure outcome in 66 patients with juvenile myoclonic epilepsy (JME) followed for a mean of nearly 45 years, investigators in Berlin, Germany, found that seizure remission occurred in 59.1% of patients, with 16.7% of all patients remaining seizure-free off antiepileptic drugs (AEDs) for at least five years before the last study contact. The results of the study, published in the December 10, 2013, issue of Neurology, suggest that treatment response and long-term remission in JME are more favorable than previously thought possible.

In addition, in identifying occurrence of absence seizures at the onset of JME as a significant predictor for poor outcome, the study points to a potentially different JME subtype—one that is indicative of a worse outcome.

Among its main findings, the study showed that, of the 39 patients who had a five-year terminal remission, 28 (71.8%) were still taking AEDs and 11 (28.2%) had been completely off medication for at least the past five years. Of the clinical variables assessed as potential predictors of seizure outcome in patients with (n = 39) and without (n = 27) remission, only additional manifestation of absence seizures at onset of JME was significantly associated with lack of five-year terminal remission.

The investigators also found, among all patients with remission, a significantly younger age at last seizure in patients who had achieved remission without AED therapy (mean age, 29.3 ± 9.3 years) versus those who had achieved remission and were currently receiving AED therapy—ie, patients with “controlled epilepsy” (39.8 ± 15 years).

Encompassing the largest cohort and longest follow-up period examining evolution of seizures in JME, as far as its authors could determine, this study demonstrated that seizures could be controlled in the majority of cases, with a significant proportion of patients off AED therapy—supporting, as lead author Philine Senf, MD, wrote, “the results of previous work showing that lifelong treatment in patients with JME may no longer apply as a general prognostic guideline.”

In an accompanying commentary, Norman K. So, MB, of the Cleveland Clinic, observed that “a proportion [of JME] remains resistant to treatment despite the advent of more and newer drugs” and that “Predictors of seizure persistence have been hard to come by,” suggesting that the identification of additional absence seizures as a predictor of unfavorable outcome is an important aspect of the “reappraisal” of JME that this study provides.

—Fred Balzac