FV 837. Early Withdrawal of Antiepileptic Medication in Patients with Juvenile Myoclonic Epilepsy Is Justifiable!

Background: Juvenile myoclonic epilepsy (JME) is an idiopathic generalized epilepsy (IGE) beginning in adolescence. Generally, a long-term therapy with AED is recommended. The data of Geithner et al and Senft et al show that early withdrawal of medication in adolescence can be expedient.

Issue: Do JME patients really have to be treated for as long as they had been in the past, preferably without interruption?

Method: Fifty-three patients are undergoing treatment for JME in our clinic: 22 males and 31 females. Average age of manifestation was around the 15th year of life (9–20 years). All patients showed the classical clinical signs of JME (symmetric/asymmetric myoclonias, generalized tonic clonic seizures, and absences in one case). Sixteen patients had a positive family history for IGE, in 6 of 53 cases, a sibling was also affected with JME; 33/53 received VPA as first choice, 9/53 LTG, 5/53 LEV, 2/53 TPM, and 1/53 sultiame. Out of 33, 10 patients on VPA changed medication due to continuing seizures or side effects (weight), LTG (n = 5), TPM (n = 3), or LEV (n = 2) and were free from seizures thereafter. Out of nine, three taking LTG and out of five, three taking LEV were seizure free after switching to VPA.

Results: Trial withdrawal of medication was undertaken in 23/53 (43.3%) patients; 30/53 refused withdrawal for various reasons: fear of seizure recurrence or job loss, medical advice, EEG not stable, continuous medical care not available, because JME patients have to take the medicine all their life, and no need to withdraw medication due to the absence of seizures. Patients who stopped medication were seizure free for the following 3.18 years on average (0.5–8 years); 12/23 (52.2%) suffered seizure recurrence, they were treated for an average of 2.7 years (1–4 years); 11/23 (47.8%) were free from seizures while not on AED and had a normal EEG; this group received antiepileptic medication for an average of 3.75 years (5–8 years). The relapse-free patients received medication on average 1 year longer; the follow-up period without AED averaged 7 years (1–16 years). All 10/12 patients who suffered relapse following withdrawal became seizure free on reversion to the original medication, 1/10 under combination therapy and 1 patient continued to experience seizures.

Conclusion: A total of 47.8% of adolescents with JME were seizure free following a trial withdrawal of their antiepileptic medication; they were treated with antiepileptic medication for 1 year longer. The dictum of long-term antiepileptic treatment far into adulthood must be questioned in the light of our findings on JME. The risk factors presented by Geithner et al for seizure relapse following withdrawal could not be confirmed in our group (EEG prior to withdrawal: 5/11 normal, 2/11 spike waves, 3/11 photosensitivity, and 1/11 unknown). A young adult with JME who was seizure free under lamotrigine died from SUDEP.

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