Idiopathic generalised epilepsies in 2026.

PURPOSE OF REVIEW: One in five patients with epilepsy has idiopathic generalized epilepsy (IGE). Novel definitions of seizure types, recent data on pharmacotherapy, and new studies on psychiatric and cognitive comorbidities will be critically discussed.

RECENT FINDINGS: Epileptic seizures have been re-classified by the International League Against Epilepsy (ILAE), acknowledging absence-to-tonic-clonic seizures and generalized negative myoclonic seizures. Differing from the classical ILAE definition of IGE subtypes, current evidence underlines that IGEs represent rather a neurobiological continuum than separate syndromes. Valproate is still the most efficacious compound to suppress myoclonic and tonic-clonic seizures, but novel data confirm the high risk for both anatomical and neurodevelopmental teratogenicity. However, switching from valproate to other antiseizure medications commonly results in seizure recurrence or worsening. As compared to the general population, persons with IGE have a two- to fourfold increased risk of psychiatric disorders, the lifetime risk is 30-50%. Bidirectional associations between IGE and psychiatric conditions suggest that the latter are integral components of a broader IGE endophenotype.

SUMMARY: Valproate continues to be the most efficacious treatment for IGE but also the most teratogenic, leaving women who plan to become pregnant in a dilemma. Psychiatric comorbidities are frequent in IGE and thus require special attention and a holistic treatment approach.