Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Acta Neurol Scand. 2019 Feb;139(2):192-198. doi: 10.1111/ane.13042. Epub 2018 Nov 15.
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.
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.
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.
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.
在青少年肌阵挛癫痫（JME）中，已不鼓励停用抗癫痫药物（AED）。然而，JME 中执行功能障碍导致的冲动可能会影响治疗依从性。本研究旨在评估在一个较大且具有代表性的 JME 群体中，停用 AED 的情况有多常见。
通过对挪威德拉门医院的病历进行回顾性搜索，确定了遗传性全面性癫痫（GGE）患者，并邀请他们进行临床访谈。对被归类为 JME 的患者进行了与 AED 停药相关的信息分析。
共对 132 名 GGE 患者进行了访谈（87 名 JME）。35 名 JME 患者（40%）停止使用 AED，其中 74%未咨询医生。JME 中自行停药的比例明显高于其他类型的 GGE。JME 自行停药组中，父母存在心理社会困难的比例明显偏高。在停止使用 AED 的 12 名患者中（34%），有 12 名患者无全身性强直阵挛发作（GTCS）且无抗癫痫药物>1 年。他们中除了 1 人外，均未咨询医生就停用了 AED。首次癫痫发作的年龄在 AED 停药结果良好的患者中明显较高。
JME 患者中自行停用 AED 的情况很常见，尤其是在家庭中存在问题的患者中。然而，约 1/3 的患者可能在没有 AED 的情况下仍无 GTCS。这些发现表明需要进行更严密的随访，并提供关于疾病预后的适当信息。
