A prospective observational study on understanding of idiopathic generalized epilepsies namely juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizure alone by electroencephalogram with updated terminology in a tertiary care hospital
DOI:
https://doi.org/10.18203/2320-6012.ijrms20223622Keywords:
Epilepsy with generalized tonic-clonic seizures alone, Juvenile myoclonic epilepsy, Myoclonic seizuresAbstract
Background: In 2017, the international league against epilepsy (ILAE) classification of epilepsies described the “genetic generalized epilepsies”, which contained the “idiopathic generalized epilepsies”. This study delineates the four syndromes comprising the IGEs: childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy (JME), and epilepsy with generalized tonic-clonic seizures alone (GTCA). JME patients usually present with myoclonic seizures, and GTCA patients present with GTCS only after awakening from sleep. Aim of the study was to identify the differences between juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizures alone by semiology and EEG with updated terminology under the observation of the clinicians.
Methods: This was a prospective observational study and was conducted in the epilepsy clinic, department of neurology, Bangabandhu Sheikh Mujib medical university, from February 2021 to July 2022. The sample size was 60.
Results: Among 60 patients, family history was present in 12 (20%) and 6 (10%) JME and GTCA patients, respectively. In this study, the EEG finding of generalized spike-wave (2.5-5.5 Hz) was seen in 26 (43%) and 19 (32%) among JME and GTCA patients, respectively. Generalized Polyspike wave (2.5-5.5 Hz) was seen in 26 (43%) JME patients, and EEG was normal in 15 out of 60 patients of epilepsy. In EEG findings, 2.5-5.5 Hz generalized spike-wave should be diagnosed in JME and GTCA patients as a special group of IGEs.
Conclusions: In this study, we have recognized and differentiated between juvenile myoclonic epilepsy and generalized tonic-clonic seizures alone by semiology and EEG in IGE syndromes as a special grouping among the IGEs is helpful as they carry prognostic and therapeutic implications.
References
Hirsch E, French J, Scheffer IE, Bogacz A, Alsaadi T, Sperling MR, et al. ILAE definition of the idiopathic generalized epilepsy syndromes: position statement by the ILAE task force on nosology and definitions. Epilepsia. 2022;63(6):1475-99.
Jallon P, Latour P. Epidemiology of idiopathic generalized epilepsies. Epilepsia. 2005;46(9):10-4.
Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord. 2015;17:117-23.
Berg AT, Levy SR, Testa FM, Shinnar S. Classification of childhood epilepsy syndromes in newly diagnosed epilepsy: interrater agreement and reasons for disagreement. Epilepsia. 1999;40:439-44.
Wirrell EC, Grossardt BR, Wong-Kisiel LC, Nickels KC. Incidence and classification of new-onset epilepsy and epilepsy syndromes in children in Olmsted County, Minnesota from 1980 to 2004: a population-based study. Epilepsy Res. 2011;95:110-8.
Canevini MP, Mai R, Di Marco C, Bertin C, Minotti L, Pontrelli V, Saltarelli A, Canger R. Juvenile myoclonic epilepsy of Janz: clinical observations in 60 patients. Seizure. 1992;1(4):291-8.
Loiseau J, Loiseau P, Guyot M, Duche B, Dartigues JF, Aublet B. Survey of seizure disorders in the French southwest. I. Incidence of epileptic syndromes. Epilepsia. 1990;31(4):391-6.
Manford M, Hart YM, Sander JW, Shorvon SD. National General Practice Study of Epilepsy (NGPSE): partial seizure patterns in a general population. Neurology. 1992;42(10):1911-7.
Commission on classification of terminology of international league against epilepsies and epileptic syndromes. Available at: https://www.ilae.org/about-ilae/topical-commissions/yes/commission-on-classification-and-terminology?. Accessed on 20 November 2021.
Juul-Jensen P, Foldspang A. Natural history of epileptic seizures. Epilepsia. 1983;24:297-312.
Syvertsen M, Nakken KO, Edland A, Hansen G, Hellum MK, Koht J. Prevalence and etiology of epilepsy in a Norwegian county-a population based study. Epilepsia. 2015;56:699-706.
Syvertsen M, Hellum MK, Hansen G, Edland A, Nakken KO, Selmer KK, et al. Prevalence of juvenile myoclonic epilepsy in people <30 years of age-a population-based study in Norway. Epilepsia. 2017;58:105-12.
Wirrell EC, Camfield CS, Camfield PR, Gordon KE, Dooley JM. Long-term prognosis of typical childhood absence epilepsy: remission or progression to juvenile myoclonic epilepsy. Neurology. 1996;47:912-8.
Martinez-Juarez IE, Alonso ME, Medina MT, Duron RM, Bailey JN, Lopez-Ruiz M, et al. Juvenile myoclonic epilepsy subsyndromes: family studies and long-term follow-up. Brain. 2006;129:1269-80.
Vorderwulbecke BJ, Kowski AB, Kirschbaum A, Merkle H, Senf P, Janz D, et al. Long-term outcome in adolescent-onset generalized genetic epilepsies. Epilepsia. 2017;58:1244-50
Beghi M, Beghi E, Cornaggia CM, Gobbi G. Idiopathic generalized epilepsies of adolescence. Epilepsia. 2006;47(2):107-10.
Thomas P, Genton P, Gelisse P, Wolf P. Juvenile myoclonic epilepsy. In: Roger J, Bureau M, Dravet Ch, Genton P, Tassinari CA, Wolf P, eds. Epileptic syndromes in infancy. Childhood and adolescence. USA: John Libbey & Co Ltd; 2002:335-55.
Obeid T, Panayiotopoulos CP. Juvenile myoclonic epilepsy: A study in Saudi Arabia. Epilepsia. 1988;29(3):280-2.
Mehndiratta MM, Aggarwal P. Clinical expression and EEG features of patients with juvenile myoclonic epilepsy (JME) from North India. Seizure. 2002;11(7):431-6.
Oflazoğlu B, Yalçin D, Öztürk F, Öncel C, Forta H. Clinical and EEG findings in juvenile myoclonic epilepsy. J Neurol Sci. 2007;24:109-14.
Panayiotopoulos CP, Obeid T, Tahan AR. Juvenile myoclonic epilepsy: a 5-year prospective study. Epilepsia. 1994;35(2):285-96.
Riasi H, Hasanzadeh TM, Nakhaee F, Salehi A. Clinical Evaluation of 32 patients with juvenile myoclonic epilepsy in Southern Khorasan. Iranian J Neurol. 2008;7(23):290-6.
Murthy JM, Rao CM, Meena AK. Clinical observations of juvenile myoclonic epilepsy in 131 patients: a study in South India. Seizure. 1998;7:43-7.
Sher SK, Rukhsana AS. Clinical and EEG characteristics of juvenile myoclonic epilepsy. Pak J Med Sci. 2014;30(1):12-5.
Vijay J, Cherian PJ, Sylaja PN, Anand A, Radhakrishnan K. Clinical characteristics of a South Indian cohort of juvenile myoclonic epilepsy probands. Seizure. 2003;12:490-6.
Marini C, Scheffer IE, Crossland KM, Grinton BE, Phillips FL, McMahon JM, et al. Genetic architecture of idiopathic generalized epilepsy: clinical genetic analysis of 55 multiplex families. Epilepsia. 2004;45:467-78.
