Long-term seizure outcomes and the likelihood of antiseizure medication withdrawal in patients with juvenile absence epilepsy: A 10-year follow-up study

Abstract

Background and Objective

Juvenile absence epilepsy is a common idiopathic generalized epilepsy syndrome that often requires long-term antiseizure medications (ASMs). However, it remains unclear whether and when such long-term medication is necessary. In this study, we aimed to explore the long-term seizure outcomes and the feasibility of ASMs withdrawal in patients with JAE. Additionally, we aimed to investigate the evolution of EEG patterns over time.

Methods

We conducted a retrospective study on patients diagnosed with JAE according to the 2022 ILAE at Xijing Hospital between March 2014 and Dec 2024. We performed a retrospective review of their 24-h video-EEG recordings for seizure semiology and EEG pattern. Patient demographics, baseline clinical characteristics, and treatment details were extracted from clinical charts and electronic health records. All further follow-up visits were either through telemedicine or in-person visits.

Results

This retrospective study included 58 patients diagnosed with JAE, with a mean age at epilepsy onset of 11.86 ± 3.87 years. The median follow-up duration was 9.57 years (range, 3–27 years). Among these patients, 38 (65.5 %) achieved seizure freedom for at least 2 years. Treatment with valproate was identified as an independent predictor of a favorable outcome in terms of seizure freedom. Conversely, the total number of generalized tonic-clonic seizures experienced, presence of absence seizures on follow-up EEG and the persistence of hyperventilation positivity on EEG were associated with an unfavorable outcome regarding seizure freedom. Among the 38 patients, 25 (65.8 %) did not experience seizure recurrence. ASMs withdrawal was attempted in 28 patients (48.3 %) and 18 of them did not experience seizure recurrence during the tapering process. Among these 18 patients, ASMs were discontinued in 9 patients at the last follow-up.

The age of onset (p = 0.040) and age at last follow up (p = 0.044) were associated with seizure recurrence. After a median EEG follow-up period of 6 years, abnormal EEG improved in 34 of the 58 patients (58.6 %). Additionally, 14 of the 58 patients (24.1 %) had normal EEG in subsequent recordings.

Conclusion

Seizures were effectively controlled with ASMs in most patients with JAE, and a significant proportion of patients were able to attempt ASMs withdrawal without experiencing seizure recurrence. Additionally, EEG patterns of GSWD improved on follow-up EEGs for the majority of patients.