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Research paper
Absence epilepsy beyond adolescence: an outcome analysis after 45 years of follow-up
  1. Martin Holtkamp,
  2. Dieter Janz,
  3. Andrea Kirschbaum,
  4. Alexander B. Kowski,
  5. Bernd J. Vorderwülbecke
  1. Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr Bernd J. Vorderwülbecke, Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin 10117, Germany; bernd.vorderwuelbecke{at}


Objectives Depending on patient age at onset, absence epilepsy is subdivided into childhood and juvenile forms. Absence seizures can occur several times per day (pyknoleptic course) or less frequently than daily (non-pyknoleptic course). Seizures typically terminate before adulthood, but a quarter of patients need ongoing treatment beyond adolescence. Little is known about their long-term seizure and psychosocial outcome.

Methods Files of 135 outpatients with absence epilepsy (76 females; 123 had additional generalised tonic–clonic seizures) were retrospectively analysed after a median follow-up of 45.4 years (IQR: 31.9–56.2). Eighty-two subjects completed an additional interview. Patients were dichotomised according to age at epilepsy onset (childhood: n=82; juvenile: n=53) and course of absence seizures (pyknoleptic: n=80; non-pyknoleptic: n=55).

Results Among all patients, 53% achieved 5-year terminal seizure remission, 16% without antiepileptic medication. Median age at last seizure was lower in patients with childhood onset of absence epilepsy (37.7 years) versus juvenile onset (44.4 years; P≤0.01). However, rates and duration of terminal seizure remission were similar. Pyknoleptic versus non-pyknoleptic course of absence seizures made no difference for long-term seizure outcome. Multivariate analysis identified only higher age at investigation to be associated with terminal 5-year seizure remission. Regarding aspects of psychosocial outcome, there were no significant differences between the respective subgroups.

Conclusions These data indicate that if absence epilepsy persists beyond adolescence, long-term seizure and psychosocial outcome do not differ between childhood and juvenile onset or between pyknoleptic and non-pyknoleptic course of absence epilepsy. However, higher patient age increases the chance of terminal seizure remission.

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  • MH and DJ contributed equally.

  • Contributors MH conceived and designed the work, analysed and interpreted the data and revised the manuscript for intellectual content. DJ conceived and designed the work and acquired, analysed and interpreted the data. AK acquired, analysed and interpreted the data. ABK analysed and interpreted the data. BJV analysed and interpreted the data and drafted the manuscript. All authors except for DJ (deceased) approved the final version of the manuscript.

  • Competing interests MH received speaker’s honoraria and/or consultancy fees from Bial, Desitin, Eisai, GlaxoSmithKline, Janssen-Cilag, LivaNova, Novartis, Shire and UCB.

  • Ethics approval The survey was approved by the Institutional Review Board of Charité – Universitätsmedizin Berlin.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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