Typical absence status epilepticus as late presentation of idiopathic generalised epilepsy in an elderly patient

Typical absence status epilepticus as late presentation of idiopathic generalised epilepsy in an elderly patient Sir Editor, Absence status epilepticus (ASE) is a type of non-convulsive status epilepticus in which continuous or recurrent generalised epileptiform discharges are associated with a varying grade of consciousness impairment. It usually occurs in patients with previous diagnosis of epilepsy, particularly in patients suffering from certain idiopathic generalised epilepsy (IGE) syndromes such as juvenile absence epilepsy or juvenile myoclonic epilepsy. In these cases, the term typical ASE is usually employed. 1 However, the episodes of ASE occurring de novo in middle-aged or elderly patients are generally considered a situation-related non-con-vulsive status epilepticus most often consequence of a benzodia-zepine withdrawal syndrome. 2,3 We describe the case of an elderly woman who presented with an episode of typical ASE as late complication of an unrecognised picture of IGE. A 68-year-old woman was admitted to our hospital because of a generalised tonic–clonic seizure (GTCS) and agitation. She had antecedents of myocardial infarction and depression on treatment with salicylic acid, lovastatine and melitracen-flupenthixol. On neurologic examination, she was disoriented to time and place, and a marked slowness in mental activity was observed. Laboratory tests and a CT scan of the brain were normal. Twelve hours later, her neurologic state was unchanged and an urgent electroencephalogram (EEG) was requested. The EEG showed frequent and recurrent generalised paroxysms of 4–6 Hz poly-spike-wave and spike-wave complexes intermixed by brief periods (2–4 s) of normal background activity (Fig. 1). The diagnosis of ASE was done. The onset of treatment of valproic acid (1 500 mg/24 h) was accompanied by a complete normal-isation of the patient mental status for the next 24 h. Subsequently , a second EEG revealed occasional generalised paroxysms of spike-wave discharges and the occurrence of a photoparox-ysmal response at rates of 5, 10 and 20 Hz. When the patient was interrogated she referred a past history of GTCSs during childhood. These seizures were never studied and no EEG was performed at that time. Magnetic resonance imaging of the brain disclosed multiple hyperintense white matter lesions of probable ischaemic origin. The patient has remained seizure-free on treatment with valproic acid for the last two years; however, several EEGs have showed occasional and brief generalised fast spike-wave discharges without clinical manifestations. The previous history of GTCSs during infancy, ictal and interictal EEG anomalies and the existence of photosensitivity support strongly the diagnosis …