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Pharmacological outcomes in juvenile myoclonic epilepsy: Support for sodium valproate
Avirup Chowdhury1, Martin J Brodie1
1Epilepsy Unit, Western Infirmary, Glasgow G11 6NT, Scotland, UK.
Insights
Juvenile myoclonic epilepsy (JME) treatment offers high seizure freedom rates. Sodium valproate (VPA) is effective, but women and those with psychiatric comorbidities may have poorer outcomes.
Area of Science:
- Neurology
- Epileptology
Background:
- Juvenile myoclonic epilepsy (JME) is a common idiopathic generalized epilepsy syndrome.
- Long-term outcome data for JME patients remain limited.
Purpose of the Study:
- To evaluate the long-term outcomes of antiepileptic drug (AED) treatment in a cohort of JME patients.
- To identify factors influencing treatment response and remission rates in JME.
Main Methods:
- Retrospective audit of 186 JME patients diagnosed between 1981 and 2012.
- Analysis of treatment duration, remission rates, AEDs used, side-effects, and prognostic factors.
Main Results:
- 92% of patients achieved remission with AEDs; 11% remained seizure-free after discontinuation.
- Sodium valproate (VPA) was the most effective monotherapy (52% remission).
- Males had higher remission rates with first/second AEDs and were more likely to receive VPA.
Conclusions:
- JME demonstrates a high success rate with AED treatment, particularly VPA.
- Women and patients with psychiatric comorbidities experienced poorer prognoses.
- Treatment strategies may need to be individualized based on patient characteristics.
Purpose:
Juvenile myoclonic epilepsy (JME) is one of the most frequently diagnosed of the idiopathic generalised epilepsy syndromes, but long term outcome data still remain sparse.
Methods:
A retrospective audit was undertaken in 186 patients (male: n=78; female: n=108) diagnosed with JME at the Epilepsy Unit at the Western Infirmary in Glasgow, Scotland between July 1981 and July 2012. Median age at treatment start was 16 years (range 13-44), with median follow-up of 14 years (range 2-32).
Results:
Overall, 171 patients (92%) achieved remission with antiepileptic drug (AED) treatment (median 9.5 years; range 1-31). After discontinuing treatment in 28 patients, only 11 remained seizure-free off medication. Fifteen patients (8%) continued to have seizures despite having tried up to 8 AED regimens: (5 male, 10 female), 7 of whom had psychiatric comorbidities. AEDs most commonly prescribed included sodium valproate (VPA; n=142), lamotrigine (LTG; n=66) and levetiracetam (LEV; n=22). More male patients than female attained remission with their first or second AED schedule (88% versus 56%). More male patients (44%) received VPA than female (31%) overall. Fewer male patients than female received LTG (26% versus 74%) and LEV (22% versus 78%). Of the monotherapies, remission was achieved using VPA (n=74; 52%), LTG (n=21; 32%) and LEV (n=12, 55%). A total of 76 (25%) of AED schedules resulted in intolerable side-effects, including 29 with VPA, 12 with LTG and 4 with LEV.
Conclusion:
Overall, JME showed a high rate of seizure freedom with AED treatment. VPA appeared to be the most effective AED. Women tended to have a worse outcome than men, since they were increasingly less likely to receive VPA. Patients with psychiatric comorbidities also had a poorer prognosis.
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