Idiopathic generalized epilepsies: Which seizure type is more difficult to control?

Objectives: The purpose of the current study was to investigate that which seizure type is more difficult to be brought under control with antiseizure medication treatment in patients with idiopathic generalized epilepsy (IGE).Methods: This was a retrospective study of a large database of patients with epilepsy, which was built over more than a decade. All patients with a diagnosis of IGE, with at least 12 months of follow-up at our center, were studied at the epilepsy center at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2022.Results: 358 patients were included. The seizure types were generalized tonic-clonic seizures (GTCSs) (in 87.2%), myoclonic seizures (in 57.5%), and absence seizures (in 51.7%). Among patients who had GTCSs (N = 312), 160 patients (51.3%) became free of this seizure type. Among patients who had myoclonic seizures (N = 206), 122 patients (59.2%) became seizure-free. Among patients who had absences (N = 185), 127 patients (68.6%) became seizure-free. The difference between the groups was significant (p = 0.0007). Receiving valproate was significantly associated with a myoclonus-free status (compared with other drugs).Significance: The likelihood of achieving seizure control is different for various seizure types in patients with IGE (achievement of seizure control is less likely for GTCSs and more likely for absences). Antiseizure drug efficacy should be considered along with other variables (e.g., sex) when selecting an ASM for a patient with IGE. Specifically designed clinical trials are needed to develop more efficacious and safe drugs to treat various syndromes of IGE.