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Acta Neurol Scand. 2019 Feb;139(2):192-198. doi: 10.1111/ane.13042. Epub 2018 Nov 15.

Antiepileptic drug withdrawal in juvenile myoclonic epilepsy.

Author information

1
Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
2
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
3
Programme for Pharmacy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
4
The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway.
5
Department of Pharmacology, Section for Clinical Pharmacology, The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway.

Abstract

OBJECTIVES:

Withdrawal of antiepileptic drugs (AEDs) has been discouraged in juvenile myoclonic epilepsy (JME). However, impulsivity as a consequence of executive dysfunction in JME may influence treatment adherence. The aim of the present study was to assess how common withdrawal of AEDs is in a large and representative JME group.

MATERIALS AND METHODS:

Patients with genetic generalized epilepsy (GGE) were identified through a retrospective search of medical records at Drammen Hospital, Norway, and invited to a clinical interview. Information related to AED withdrawal was analyzed in those classified as JME.

RESULTS:

A total of 132 patients with GGE were interviewed (87 JME). Thirty-five patients with JME (40%) discontinued AEDs, of which 74% did so without consulting a doctor. The rate of self-withdrawal was significantly higher in JME than in other types of GGE. Having a parent with psychosocial difficulties was significantly over-represented in the JME self-withdrawal group. Twelve of those who discontinued AEDs (34%) were free from generalized tonic-clonic seizures (GTCS) and without antiepileptic drugs >1 year. All but one of them withdrew AEDs without consulting a doctor. Age at first motor seizure was significantly higher in those with a favorable outcome of AED withdrawal.

CONCLUSIONS:

Self-withdrawal of AEDs is common in JME, especially in those with troublesome conditions at home. However, about 1/3 may remain free from GTCS without AEDs. The findings indicate a need for a stronger follow-up with appropriate information about the prognosis of the disorder.

KEYWORDS:

adherence; antiepileptic drugs; juvenile myoclonic epilepsy; withdrawal

PMID:
30378684
DOI:
10.1111/ane.13042
[Indexed for MEDLINE]

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