Abstracts

Rationale: Idiopathic generalized epilepsies (IGE) are generally viewed as having favorable outcomes, but seizures often persist despite medical therapy. We aimed to describe the evidence surrounding the factors associated with achieving seizure remission (SR) in adults. Methods: Medline and Embase were searched using sub-headings and keywords related to IGE, remission, seizure freedom, and refractoriness in adults. Two independent reviewers screened abstracts and full-text articles and abstracted data from eligible studies. Included studies were original research reporting on factors associated with SR in adults with IGE. Analyses were done in three phases to 1) assess sample characteristics, and 2) assess the factors associated with SR. Results: Of 3601 abstracts, 211 were reviewed in full-text, and 35 meet eligibility criteria. The median number of patients across the studies was 90.5 (range: 17-962). Sixteen studies reported on patients with IGE, thirteen with juvenile myoclonic epilepsy (JME), four on juvenile absence epilepsy (JAE), and two on absence epilepsy. SR ranged from 22.4% to 65% across the studies. In five studies, aspects of absence seizures were significantly associated with a lack of SR. Patients who experienced absence seizures were significantly less likely to achieve SR (p=0.001). In two studies the pattern of absence seizures (sporadic vs. daily/monthly and pyknoleptic vs. not) was significantly associated with a lack of SR (p=0.004 and p=0.04). In another, absence seizures persisting >12 years were associated with a lack of SR (p<0.05). Finally, JAE had significantly worse seizure prognosis than other IGE syndromes (p=0.02). Psychiatric comorbidity was associated with SR. Three studies found significantly lower prevalence of psychiatric disorders in patients who achieved SR (19%, 21.9%, and 19.5% respectively) compared to patients who had not achieved SR (58.3%, 75%, and 40.5% respectively). Another study reported fewer psychiatric conditions among patients with good seizure control compared to those with moderate/poor seizure control (25% vs. 4%, p = .029). Lastly, one study found a significant association between use of two or more psychotropic drugs and a lack of SR. The number of seizure types was associated with SR; 62.5% and 72% of patients with poorly controlled seizures had >