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. 2025 Feb 22;272(3):218.
doi: 10.1007/s00415-025-12890-y.

Seizure freedom and therapy discontinuation in patients with idiopathic generalized epilepsy: retrospective cohort study from a tertiary epilepsy outpatient service

Davide G Curti  1   2   3 , Anna Bellini  1   2 , Marco Cursi  2 , Jacopo Lanzone  1   2   4 , Fabio Minicucci  2 , Giovanna F Fanelli  1   2 , Federica Agosta  1   3   4   5 , Massimo Filippi  6   7   8   9   10   11
Affiliations

Seizure freedom and therapy discontinuation in patients with idiopathic generalized epilepsy: retrospective cohort study from a tertiary epilepsy outpatient service

Davide G Curti et al. J Neurol. .

Abstract

Background: Idiopathic generalized epilepsy (IGE) affects young individuals and is typically successfully managed with anti-seizure medications (ASMs). Discontinuing therapy in IGE patients is a critical decision due to the risk of seizure recurrence. This study aims to identify factors influencing seizure freedom (SF) or relapse after ASM discontinuation.

Methods: We retrospectively reviewed the medical records of patients seen at our clinic between 2002 and 2024. Collected data included demographics, disease history, seizure types, ASMs used, EEG findings, outcomes related to SF and ASM withdrawal.

Results: We identified 322 records, with a mean age of 30 ± 12.4 years and an age at onset of 16 ± 5.9 years. On average, patients tried 1.9 ASMs, 23% on polytherapy. The main seizure types were generalized tonic-clonic seizures (GTCS) in 53.1%, myoclonic seizures in 31.7%, absences in 15.2%. SF was achieved by 76.6%. Patients with GTCS as main seizure type or presenting with GTCS in the first year of disease experienced a delayed achievement of SF. ASM discontinuation was attempted in 64 patients. Predictors of relapse after discontinuation were myoclonic and generalized seizures as principal seizure type and higher seizure frequency. Early SF and lower seizure frequency were associated with successful discontinuation. EEG predictors of discontinuation failure included worsening during treatment tapering and specific abnormalities, such as spike waves, photosensitivity, and hyperpnoea sensitivity.

Conclusions: This study provides long-term follow-up data on IGE patients, highlighting key predictors of seizure control, including GTCS or myoclonic seizures and a rapid initial ASM response. EEG emerges as a valuable tool for the longitudinal monitoring of patients undergoing ASM discontinuation.

Keywords: Antiseizure medication withdrawal; Epilepsy; Idiopathic generalized epilepsy; Seizure freedom.

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Conflict of interest statement

Declarations. Conflicts of interest: Davide Gusmeo Curti, Anna Bellini, Marco Cursi, Jacopo Lanzone, Fabio Minicucci, Giovanna Franca Fanelli have no relevant conflicts of interest. M. Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology; received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi; speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme; he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. F. Agosta is Associate Editor of NeuroImage: clinical, has received speaker honoraria from Biogen Idec, Italfarmaco, Roche, Zambon and Eli Lilly, and receives or has received research supports from the Italian Ministry of Health, the Italian Ministry of University and Research, AriSLA (Fondazione Italiana di Ricerca per la SLA), the European Research Council, the EU Joint Programme–Neurodegenerative Disease Research (JPND), and Foundation Research on Alzheimer Disease (France). Ethical approval: A written informed consent was obtained from all subjects according to the Declaration of Helsinki before enrolment in the study. The study protocol was approved by the Ethics Committee of IRCCS Ospedale San Raffaele. Declaration of generative AI: The authors did not use any use generative artificial intelligence (AI) and AI-assisted technologies in the writing process.

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