Scientific Reports (Feb 2022)

Sex-specific disease modifiers in juvenile myoclonic epilepsy

  • Amy Shakeshaft,
  • Naim Panjwani,
  • Amber Collingwood,
  • Holly Crudgington,
  • Anna Hall,
  • Danielle M. Andrade,
  • Christoph P. Beier,
  • Choong Yi Fong,
  • Elena Gardella,
  • Joanna Gesche,
  • David A. Greenberg,
  • Khalid Hamandi,
  • Jeanette Koht,
  • Kheng Seang Lim,
  • Rikke S. Møller,
  • Ching Ching Ng,
  • Alessandro Orsini,
  • Mark I. Rees,
  • Guido Rubboli,
  • Kaja K. Selmer,
  • Pasquale Striano,
  • Marte Syvertsen,
  • Rhys H. Thomas,
  • Jana Zarubova,
  • Mark P. Richardson,
  • Lisa J. Strug,
  • Deb K. Pal

DOI
https://doi.org/10.1038/s41598-022-06324-2
Journal volume & issue
Vol. 12, no. 1
pp. 1 – 12

Abstract

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Abstract Juvenile myoclonic epilepsy (JME) is a common idiopathic generalised epilepsy with variable seizure prognosis and sex differences in disease presentation. Here, we investigate the combined epidemiology of sex, seizure types and precipitants, and their influence on prognosis in JME, through cross-sectional data collected by The Biology of Juvenile Myoclonic Epilepsy (BIOJUME) consortium. 765 individuals met strict inclusion criteria for JME (female:male, 1.8:1). 59% of females and 50% of males reported triggered seizures, and in females only, this was associated with experiencing absence seizures (OR = 2.0, p < 0.001). Absence seizures significantly predicted drug resistance in both males (OR = 3.0, p = 0.001) and females (OR = 3.0, p < 0.001) in univariate analysis. In multivariable analysis in females, catamenial seizures (OR = 14.7, p = 0.001), absence seizures (OR = 6.0, p < 0.001) and stress-precipitated seizures (OR = 5.3, p = 0.02) were associated with drug resistance, while a photoparoxysmal response predicted seizure freedom (OR = 0.47, p = 0.03). Females with both absence seizures and stress-related precipitants constitute the prognostic subgroup in JME with the highest prevalence of drug resistance (49%) compared to females with neither (15%) and males (29%), highlighting the unmet need for effective, targeted interventions for this subgroup. We propose a new prognostic stratification for JME and suggest a role for circuit-based risk of seizure control as an avenue for further investigation.