Abstracts

Rationale: Epidemiologic data concerning idiopathic generalized epilepsies (IGEs) are often unreliable because most descriptive studies did not specifically analyze these syndromes or the bases for diagnoses were not always available. This study addresses the clinical management and response to treatment in a well-evaluated cohort of patients with IGE. Methods: Hospital records of all our patients with IGE (N=120; aged 17-74; 66% women) were retrospectively evaluated. Epilepsy syndromes included juvenile myoclonic (47%), IGE with only generalized tonic-clonic (GTC) seizure (32%), juvenile absence (8%), unclassified IGE (7%), childhood absence (4%) and others (2%). Logistic regression analysis was performed where applicable. Results: About four fifths (94/120) of patients were 1-year seizure-free and only 13% (16/120) still had GTC. 57% of 7 patients with no medication, 86% of 89 monotherapy patients, 60% of 20 duotherapy patients and 25% of 4 patients on three anti-epileptic drugs (AEDs) were seizure-free. 74% of monotherapy patients were on valproate and 11% on lamotrigine. Lamotrigine was significantly less effective than valproate (OR 0.10; 95% CI 0.02-0.45). Seizure-freedom increased from 78% to 85% during the 3-year follow-up (2005-08). Conclusions: High proportion of seizure-freedom with combination therapy emphasizes the usefulness of polytherapy in achieving seizure-freedom in epilepsies refractory to single AED. Long term treatment of unprovoked GTC in IGE patients is successful in the majority (98%) of cases. Refractory GTC seizure in IGE is rare; the possible causes may include wrong diagnosis, inappropriate medication, poor compliance, or an underlying provoking factor. Women with IGE have a better prognosis than men, provided they avoid provoking factors.