[Generalized idiopathic epilepsy in older children and adolescents]
N Badinand-Hubert1, H Isnard, C Berger
1Service explorations fonctionnelles neurologiques, hôpital Debrousse, Lyon, France.
Insights
Juvenile idiopathic epilepsies, including juvenile myoclonic epilepsy, often begin in adolescence. Early diagnosis and consistent treatment are key, though relapses can occur after stopping medication.
Area of Science:
- Neurology
- Epileptology
- Clinical Neuroscience
Context:
- Focuses on generalized idiopathic epilepsies with onset between 12 and 18 years.
- Highlights common syndromes: juvenile myoclonic epilepsy, juvenile absence epilepsy, and grand-mal seizures upon awakening.
Purpose:
- To detail the EEG and clinical seizure characteristics of these adolescent-onset epilepsies.
- To review therapeutic strategies, prognoses, and familial/molecular genetic aspects.
- To emphasize diagnostic importance of overlooked morning myoclonias and differential diagnoses.
Summary:
- Discusses differential diagnosis, including absences, frontal seizures, partial epilepsy, and progressive myoclonic epilepsy.
- Addresses frequent psycho-social challenges and issues with therapeutic compliance.
- Notes generally good therapeutic outcomes but a high relapse rate upon medication withdrawal.
Impact:
- Aids in accurate diagnosis of adolescent-onset idiopathic epilepsies.
- Informs treatment strategies and prognosis discussions.
- Highlights the need for long-term management and patient support to minimize relapse.
Abstract:
Generalized idiopathic epilepsies starting between 12 and 18 years of age are mostly represented by juvenile myoclonic epilepsy, juvenile absence epilepsy and grand-mal on awakening. The EEG and clinical description of the seizures, the different epileptic syndromes with their therapeutics, the prognosis and the familial forms with the molecular genetic aspects are studied. The importance of the history for the positive diagnosis is emphasized, in order to display the often overlooked myoclonies occurring in the morning. Differential diagnosis concerns mostly absences which are sometimes difficult to separate from frontal seizures, and in the case of first generalized tonico-clonic seizure, partial epilepsy which needs further investigations, and the exceptional progressive myoclonic epilepsy which begins the same way, but has a totally different prognosis. Psycho-social difficulties due to epilepsy and lack of therapeutic compliance are frequent. The therapeutic results are generally good but there is a high rate of relapse after medication withdrawal.
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