{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:17:57Z","timestamp":1790691477588,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,10,7]],"date-time":"2018-10-07T00:00:00Z","timestamp":1538870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>\n                      Juvenile myoclonic epilepsy (JME) is a common epilepsy syndrome for which treatment response is generally assumed to be good. We aimed to determine the prevalence and prognostic risk factors for refractoriness of\n                      <jats:styled-content style=\"fixed-case\">JME<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We systematically searched PubMed and EMBASE and included 43 eligible studies, reporting seizure outcome after antiepileptic drug (AED) treatment in\n                      <jats:styled-content style=\"fixed-case\">JME<\/jats:styled-content>\n                      cohorts. We defined refractory\n                      <jats:styled-content style=\"fixed-case\">JME<\/jats:styled-content>\n                      as persistence of any seizure despite AED treatment and performed a random\u2010effects meta\u2010analysis to assess the prevalence of refractory\n                      <jats:styled-content style=\"fixed-case\">JME<\/jats:styled-content>\n                      and of seizure recurrence after AED withdrawal in individuals with well\u2010controlled seizures. Studies reporting potential prognostic risk factors in relation to seizure outcome were included for subsequent meta\u2010analysis of risk factors for refractoriness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 35% (95% confidence interval, 29\u201341%) of individuals (\n                      <jats:italic>n<\/jats:italic>\n                      = 3311) were refractory. There was marked heterogeneity between studies. Seizures recurred in 78% (95% confidence interval, 52\u201394%) of individuals who attempted to withdraw from treatment after a period of seizure freedom (\n                      <jats:italic>n<\/jats:italic>\n                      = 246). Seizure outcome by publication year suggested that prognosis did not improve over time. Meta\u2010analysis suggested six variables as prognostic factors for refractoriness, i.e. having three seizure types, absence seizures, psychiatric comorbidities, earlier age at seizure onset, history of childhood absence epilepsy and praxis\u2010induced seizures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      One\u2010third of people with\n                      <jats:styled-content style=\"fixed-case\">JME<\/jats:styled-content>\n                      were refractory, which is a higher prevalence than expected. Risk factors were identified and can be used to guide treatment and counselling of people with\n                      <jats:styled-content style=\"fixed-case\">JME<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.13811","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T19:43:45Z","timestamp":1537213425000},"page":"856-864","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":94,"title":["Refractory juvenile myoclonic epilepsy: a meta\u2010analysis of prevalence and risk factors"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0214-7965","authenticated-orcid":false,"given":"R.","family":"Stevelink","sequence":"first","affiliation":[{"name":"Department of Child Neurology Brain Center Rudolf Magnus University Medical Center Utrecht Utrecht"},{"name":"Department of Genetics Center for Molecular Medicine University Medical Center Utrecht Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. P. C.","family":"Koeleman","sequence":"additional","affiliation":[{"name":"Department of Genetics Center for Molecular Medicine University Medical Center Utrecht Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. W.","family":"Sander","sequence":"additional","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede The Netherlands"},{"name":"UCL Institute of Neurology NIHR University College London Hospitals Biomedical Research Centre London"},{"name":"Chalfont Centre for Epilepsy Chalfont St Peter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. E.","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Child Neurology Brain Center Rudolf Magnus University Medical Center Utrecht Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. P. 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