Effects of patient and seizure-related factors on drug load in seizure-free patients with idiopathic generalized epilepsy

Introduction: Idiopathic generalized epilepsies (IGEs) include four different epilepsy syndromes and IGE have mostly a good response to antiepileptic drugs (AEDs). The most common IGE subgroup is juvenile myoclonic epilepsy (JME). It generally responds well to low doses of AEDs; however, some patients need higher doses of medication. In this study was hypothesized that patient and epilepsy characteristics of seizure-free patients with high drug load might differ from those with low drug load. For this purpose, it was aimed to compare patients with JME and patients with other generalized epilepsies (non-JME IGE) regarding these factors concerning drug load. Patients and Methods: The records of the epilepsy outpatient clinic from 2010 to 2020 were retrospectively evaluated for patients with IGEs. Patients without any epileptic seizures in the last year were accepted as seizure-free. Drug load is calculated by dividing the prescribed daily dose by defined daily dose (PDD/DDD). A total drug load (TDL) equal to one and greater was considered as a high TDL (≥1, high-TDL group), where a drug load of below one was considered as a low TDL (<1, low-TDL group). The high-TDL and low-TDL groups in patients with JME and non-JME IGE were compared in terms of sociodemographic characteristics, personal and family histories, duration of epilepsy, seizure characteristics, epilepsy syndromes, electroencephalography findings, and AEDs and doses. Results: In this study, 119 patients (69 females, 50 males) with a mean age of 30.11 (range, 18–65) years were included. The mean age of onset and duration of the disease was 16.21 (range, 3–47) years and 13.6 (1–45) years, respectively. Sixty-three of the patients were diagnosed as having JME, and 56 patients were diagnosed as having non-JME IGE (39 with generalized tonic-clonic seizures alone, 17 juvenile absence epilepsy). According to the TDL, 35 patients were classified in the low-TDL group and 84 patients in the high-TDL group. The age of disease onset was higher in the non-JME IGE group (P = 0.027). Triple-type seizures were significantly more common in the JME group (P < 0.001). No statistically significant differences were found between the low- and high-TDL groups regarding patient and epilepsy characteristics in the JME and non-JME IGE groups. Conclusion: Most seizure-free patients had low-TDL in the JME and non-JME IGE groups. No association was observed in the JME and non-JME IGE groups regarding the total AED load.