Archives de pediatrie : organe officiel de la Societe francaise de pediatrie · 2025
Seizure freedom in pediatric juvenile myoclonic epilepsy: The roles of cognition, chronodependency, and EEG.
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Akça Ünal, Sanrı Emre, Akça Gülfer
Аннотация
OBJECTIVE: To identify clinical, chronobiological, and electroencephalographic (EEG) predictors of seizure freedom in pediatric patients with juvenile myoclonic epilepsy (JME), and to evaluate the prognostic utility of both classic and novel markers in a real-world setting.
METHODS: We conducted a retrospective cohort study of 71 pediatric JME patients (mean age at diagnosis 16.1 ± 1.05 years; 76.1 % female) diagnosed at a single tertiary center between January 2023 and January 2025. Data collected included demographic variables, seizure characteristics, academic performance, comorbidities, antiseizure medication use, and detailed EEG findings. Classic (e.g., seizure type, academic achievement) and novel predictors (e.g., chronodependency) were assessed for their association with seizure outcome. Chronodependency was defined as a pattern of seizures predominantly occurring after awakening or during specific circadian periods. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed.
RESULTS: At last follow-up, 63.4 % (n = 45) of patients achieved seizure freedom. High academic performance (OR=42.00, p < 0.001) and initial myoclonic seizure type (OR=6.96, p < 0.001) were strongly associated with seizure freedom, whereas high initial frequency of generalized tonic-clonic seizures (OR=0.05, p < 0.001) and failure of at least two appropriate antiseizure medications (OR=0.07, p < 0.001) predicted poor outcomes. Among novel predictors, chronodependency (OR=0.29, p = 0.025), major focal EEG abnormalities (OR=0.30, p = 0.038), and EEG hyperventilation response (OR=0.35, p = 0.025) were independent negative prognostic factors. The full multivariate model, integrating classic and novel predictors, demonstrated excellent discriminative performance (AUC=0.96). Levetiracetam was the most frequently prescribed monotherapy, reflecting the predominance of adolescent and female patients; multidrug regimens were linked to poor seizure control.
CONCLUSION: Seizure outcome in pediatric JME is influenced by a complex interplay of cognitive, chronobiological, and electrographic factors. Integrating academic performance, seizure type, chronodependency, and advanced EEG findings enhances prognostication and supports a personalized, multidimensional approach to management. Early identification of at-risk patients may inform tailored interventions and improve long-term outcomes.
METHODS: We conducted a retrospective cohort study of 71 pediatric JME patients (mean age at diagnosis 16.1 ± 1.05 years; 76.1 % female) diagnosed at a single tertiary center between January 2023 and January 2025. Data collected included demographic variables, seizure characteristics, academic performance, comorbidities, antiseizure medication use, and detailed EEG findings. Classic (e.g., seizure type, academic achievement) and novel predictors (e.g., chronodependency) were assessed for their association with seizure outcome. Chronodependency was defined as a pattern of seizures predominantly occurring after awakening or during specific circadian periods. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed.
RESULTS: At last follow-up, 63.4 % (n = 45) of patients achieved seizure freedom. High academic performance (OR=42.00, p < 0.001) and initial myoclonic seizure type (OR=6.96, p < 0.001) were strongly associated with seizure freedom, whereas high initial frequency of generalized tonic-clonic seizures (OR=0.05, p < 0.001) and failure of at least two appropriate antiseizure medications (OR=0.07, p < 0.001) predicted poor outcomes. Among novel predictors, chronodependency (OR=0.29, p = 0.025), major focal EEG abnormalities (OR=0.30, p = 0.038), and EEG hyperventilation response (OR=0.35, p = 0.025) were independent negative prognostic factors. The full multivariate model, integrating classic and novel predictors, demonstrated excellent discriminative performance (AUC=0.96). Levetiracetam was the most frequently prescribed monotherapy, reflecting the predominance of adolescent and female patients; multidrug regimens were linked to poor seizure control.
CONCLUSION: Seizure outcome in pediatric JME is influenced by a complex interplay of cognitive, chronobiological, and electrographic factors. Integrating academic performance, seizure type, chronodependency, and advanced EEG findings enhances prognostication and supports a personalized, multidimensional approach to management. Early identification of at-risk patients may inform tailored interventions and improve long-term outcomes.