Contrary to popular belief, first-line anti-seizure medication often fails to provide seizure freedom in combination with good tolerability. Neuropsychological and imaging studies indicate similar abnormalities in unaffected relatives of patients with GGE, supporting the concept that underlying alterations in bilateral frontothalamocortical networks are genetically determined. Evidence has shown that the mode of inheritance in GGE is mostly polygenic. Novel insights into the genetic aetiology, comorbidities and prognosis of the GGE syndromes have emerged and challenge traditional concepts about these conditions. However, in ~20% of patients with GGE, characteristics of more than one syndrome are present. These four GGE syndromes are childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with generalized tonic–clonic seizures alone. Genetic generalized epilepsy (GGE) syndromes start during childhood or adolescence, and four commonly persist into adulthood, making up 15–20% of all cases of epilepsy in adults.
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