Researchers at University of Greifswald, Germany; and Cleveland Clinic, OH, studied the long-term seizure outcome in patients with juvenile myoclonic epilepsy (JME) and identified factors predictive of seizure remission. Of 31 patients followed for at least 25 years (mean 39.1 years), 21 (67.7%) were seizure-free, and 6 (28.6%) had AEDs discontinued. Significant predictors for a poor long-term seizure outcome included occurrence of generalized tonic-clonic seizures (GTCS) preceded by bilateral myoclonic seizures (p=0.03), long duration of drug refractory epilepsy (p=0.022), and AED polytherapy (p=0.023). Complete remission of GTCS with AED significantly increases the chance for complete seizure freedom (p=0.012). Photoparoxysmal responses significantly increase risk of seizure recurrence after AED discontinuation (p=0.05). Long-term seizure freedom in two thirds of patients and validation of outcome predictors should permit clinicians to provide patients with a more favorable potential response to treatment. [1]

COMMENT. A previous long-term study of JME in 24 patients, 25.8 years after seizure onset, found that 11 (48%) had discontinued treatment and 6 (25%) were seizure-free without AEDs for 5-23 years [2]. Contrary to current opinion, these reports show that continuation of AED therapy in JME is not required in all patients, and predictive factors for long-term management and outcome are now available.