In the five years before diagnosis, patients with IGE were more commonly prescribed psychiatric medications and had higher healthcare use than matched controls.

Idiopathic generalised epilepsy (IGE) includes the syndromes juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with only generalised tonic-clonic seizures. These syn­dromes share genetic and clinical features (e.g. cognitive deficits, impulsivity and personality and psychiatric disorders). Patients with IGE have a higher rate of psychiatric comorbidities than controls.

However, it is unclear whether these comorbidities are prodromal for IGE or sequelae. To clarify the sequence of this association, researchers studied two mutually exclusive IGE patient cohorts diagnosed over the same 13­-year period: one based on ICD­10 code identification in a Danish national registry and the other from a Danish tertiary epilepsy centre. Each IGE case was compared with 10 age­, sex­ and geography­ matched controls from the national registry.

In the five years before diagnosis, the 1009 patients with IGE in the national registry (mean age, 16 years) had more contacts with hospitals (8.3 vs 6.6) and general practitioners (48.7 vs 45.3) than controls had and more frequently received prescriptions for psychiatric medications (4.2% vs 2.5%). Patients with IGE had a higher rate of psychiatric comorbidity (26.5% vs 17.8%) at the end of the study, most commonly anxiety (35%), with no differences in rate of psychoactive substance use nor personality disorders compared with controls. Similar patterns were seen in the 402 patients (mean age, 18 years) in the tertiary­-centre cohort. 

Comment: These findings should prompt clinicians to consider IGE in teenage patients with frequent healthcare contacts and new psychiatric symptoms, parti­ cularly if family members have similar or milder cognitive deficits, personality disorders or psychiatric disorders, given the genetic aspects of these syndromes. Some IGE seizures can be subtle, so neurology consultation is important to consider when such patients develop staring spells, eye flutter episodes, automatisms or brief, involuntary muscle contractions. Also, general practitioners and neurologists should monitor patients with IGE for anxiety and other psychiatric comorbidities.

John C. Probasco, MD, Professor, Department of Neurology, and Director, Division of Advanced Clinical Neurology, Johns Hopkins University School of Medicine, Baltimore, USA.

Gesche J, et al. Prodromal phase of idiopathic generalized epilepsy: a register-based case control study. Neurology 2024; 103: e209921.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.