High rates of early remission pattern in adult-onset compared with earlier-onset idiopathic generalized epilepsy: A long-term follow-up study. (January 2022)

• Record Type: Journal Article
• Authors: Cerulli Irelli, Emanuele; Orlando, Biagio; Salamone, Enrico M; Fisco, Giacomo; Barone, Francesca A; Morano, Alessandra; Fanella, Martina; Fattouch, Jinane; Manfredi, Mario; Giallonardo, Anna T; Di Bonaventura, Carlo
• Is Part Of: Seizure. Volume 94(2022)
• Page Start: 52
• Page End: 56
• Publication Date: 2022-01
• Subjects: Idiopathic generalized epilepsy (IGE) -- Long-term seizure outcome -- Late-onset -- Antiseizure medication (ASM) withdrawal -- prognostic factors -- prognostic patterns; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2021.11.019
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: IGE-GTCS only was the most commonly observed syndrome in adult-onset patients. A lower rate of photosensitivity and absence seizures was observed in adult-onset IGE. 24-h EEG recording highlighted similar rates of generalized fast activities in adult and. younger patients. Most adult-onset patients showed early and sustained seizure freedom after ASM prescription. Abstract: Objective: To investigate electroclinical characteristics and prognostic patterns of adult-onset vs. younger-onset idiopathic generalized epilepsy (IGE) patients during long-term follow-up. Methods: In this single-center retrospective cohort comparative study, adult-onset IGE was defined as onset after 20 years of age. Patients with a follow-up duration between 10 and 30 years from epilepsy diagnosis were enrolled. Maximum follow-up duration was limited to 30 years to ensure a better comparison of prognostic data between adult-onset and younger-onset patients. The Benjamini-Hochberg false discovery rate (FDR) method was applied to obtain FDR-adjusted p-values. Results: A total of 177 IGE patients were recruited and 27 adult-onset IGE patients were identified (15.3%). Follow-up duration was similar between younger- and adult-onset IGE patients and 74% of subjects performed at least one 24-hour EEG recording. Of adult-onset IGE patients, 8/27 were diagnosed with juvenile myoclonic epilepsy, while 19/27 were diagnosed with generalized tonic-clonic seizures (GTCS) only. EEG photosensitivity and absence seizures were significantly less frequent among adult-onset IGE patients as compared with younger subjects. When considering prognostic patterns, an early remission pattern was significantly higher among adult-onset IGE patients as compared with younger-onset IGE patients (55.6% vs. 24%, adjusted p value = 0.007). Antiseizure medication withdrawal was attempted in 3/27 adult-onset patients, and all had GTCS relapses. Conclusion: Our study contributes to better defining the electroclinical characteristics and long-term follow-up of adult-onset IGE patients. A favorable long-term seizure outcome was found in adult-onset IGE patients, as evidenced by the high rates of early remission pattern when compared with younger onset patients.