Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
Seizure. 2021 Mar;86:41-48. doi: 10.1016/j.seizure.2021.01.005. Epub 2021 Jan 23.
Juvenile myoclonic epilepsy (JME), like other forms of idiopathic generalized epilepsy, shows a marked female predominance. However, few studies have specifically addressed the role of sex in its long-term prognosis. We performed a systematic review of the literature relevant to JME prognosis, focusing on sex-based differences in prognostic factors and outcome.
A comprehensive literature search of the PubMed and Scopus databases was performed, considering all articles up to April 2020 in which long-term prognosis in JME had been explored and sex differences in outcome or prognostic factors were specified.
We included 25 articles published between 1984 and 2020. Sex differences in epilepsy outcome were explored by 21 of the 25 studies, but only three reported different outcomes in male vs female patients. All three found female sex to be associated with a later response to antiseizure medications, worse seizure control, and a higher risk of relapse in their entire study samples, which included JME patients. Eight studies found sex-based differences in possible predictors of long-term outcome: prolonged epileptiform EEG runs and the presence of eye closure sensitivity, both more frequent in women, were factors possibly linked to a poorer prognosis, as were praxis induction and generalized EEG asymmetric changes, which instead were more common in men. Valproate use, more frequent in men, was associated with a better outcome.
Most studies do not highlight sex differences in JME prognosis. However, some sex specificities do emerge, especially with regard to particular reflex traits and EEG abnormalities. Finally, sex may condition therapeutic choices, and thus have a possible impact on long-term outcome.
青少年肌阵挛性癫痫（JME）与其他特发性全面性癫痫一样，表现出明显的女性优势。然而，很少有研究专门探讨性别在其长期预后中的作用。我们对 JME 预后相关的文献进行了系统回顾，重点关注性别在预后因素和结局方面的差异。
对 PubMed 和 Scopus 数据库进行了全面的文献检索，考虑了截至 2020 年 4 月所有探讨 JME 长期预后且明确性别差异对结局或预后因素影响的文章。
我们纳入了 1984 年至 2020 年期间发表的 25 篇文章。25 篇研究中有 21 篇探讨了癫痫结局的性别差异，但只有 3 篇报告了男性和女性患者的不同结局。这 3 项研究均发现女性在整个研究样本中对抗癫痫药物的反应较晚，癫痫控制较差，复发风险较高，其中包括 JME 患者。8 项研究发现了长期预后的可能预测因素中的性别差异：延长的癫痫样 EEG 发作和闭眼敏感性的存在，女性更为常见，这些因素可能与预后较差有关，而实践诱导和广泛的 EEG 不对称性改变则更为常见于男性。丙戊酸的使用更为常见于男性，与更好的结局相关。
大多数研究没有强调 JME 预后的性别差异。然而，确实出现了一些性别特异性，尤其是在特定的反射特征和 EEG 异常方面。最后，性别可能影响治疗选择，从而可能对长期预后产生影响。
