Abstracts

Rationale: This study aims to describe the outcomes and trends in antiseizure medication (ASM) use in idiopathic generalized epilepsy (IGE) patients in a single-center and non-pediatric setting, focusing on sex differences.

Methods: A retrospective review was conducted of patients at the Yonsei Epilepsy Clinic from April 2000 to March 2024, with a minimum follow-up of 2 years. Seizure freedom (SF) was defined as no seizures including generalized tonic-clonic, myoclonic and absence seizures for > 2 years. Drug-resistant IGE was defined as failure of adequate trials of two tolerated, appropriately used ASM to achieve SF.

Results: Of the 4606 patients followed up for epilepsy, 516 (11.2%) patients were diagnosed with IGE. Three hundred and nineteen patients were included with a median follow-up of 115 months, 165 (51.7%) were female and 154 (48.3%) were male.
Juvenile myoclonic epilepsy (JME) was the most common subtype (58.9%), followed by juvenile absence epilepsy (JAE) (17.2%), generalized tonic-clonic seizures alone (GTCA) (16.6%), and childhood absence epilepsy (CAE) (7.2%).
Two hundred and sixty (81.5%) patients achieved SF, with no significant sex difference (p=0.248, 78.8% in female and 84.4% in male). The SF rate in JME patients was 79.8%, JAE was 78.2%, GTCA was 90.6%, and CAE was 82.6%. Forty-five (14.1%) patients met the definition of drug-resistant IGE with no sex difference (p=0.262). More female than male switched ASMs during follow-up (p< 0.001). SF rates were slightly higher in those who did not switch ASMs during follow-up compared to those who did (p=0.049). Valproate was more commonly used in male than in female (p< 0.001), but was the most commonly prescribed medication in both sexes (69.1% in female, 90.9% in male). The second most commonly prescribed medication was lamotrigine (65.5% in female, 40.9% in male). Valproate use was not associated with SF rates in patients overall (p=0.728), or in female or male (p=0.838 and p=0.474, respectively). One hundred and fifty-four patients were female in reproductive age when treatment was started, and 68.8% of them were exposed to valporate during follow-up, and no significant difference in SF rate was found between patients who were exposed to valproate and those who were not (p=0.802). The rate of switching from valproate to alternative medications was higher in female compared to male (p< 0.001). Among 46 female patients who switched valproate, 56.5% was due to pregnancy-related issues, 30.4% due to side effects, and 13% due to efficacy. Valproate was discontinued due to side effects in all 11 male patients. Patients who were on monotherapy at last observation had higher SF rates than those who were on polytherapy (p=0.009). There were no sex differences in the rate of monotherapy at last observation (p=0.498). Logistic regression analysis showed that monotherapy at last observation was strongly associated with SF rates (p=0.009).


Conclusions: There were no significant differences in the medical treatment outcome of IGE patients between the sexes, and the outcome seemed to be associated with finding appropriate monotherapy through sufficient attempts to change the ASM.

Funding: The authors report no targeted fundings.