Abstracts

Rationale: It is well known the fact that Childhood Absence Epilepsy (CAE) can be associated with minor motor automatisms, the best example of that is the repetitive blinking and minor motor contractions on the neck during an event, however other associated motor findings can be present and if the clinician does not elaborate on the nature of the movements potential errors in medication titration can occur, mistakenly thinking that seizures are not controlled. Wanted to evaluate the prevalence and nature of associated abnormal movements not related to epilepsy in children previously diagnosed with CAE. Methods: Of a population of 12 CAE cases we identified the subjects that recurrently were labeled as not controlled despite appropriate doses of anticonvulsants with proper follow up for at least 6 months. Results: The cases included 5 males and 7 females the mean age was 9.5 years old, the mean seizure onset was 6.5 years. The patients were diagnosed based on clinical criteria and electroencephalogram. The medications at the time of evaluation were ethosuximide, valproic acid, levetiracetam and lamotrigine. More than 70 % of the cases were taking 2 antiepileptics due to refractory seizures. More than 60% of the patients were studied with video-electroencephalogram due to recurrent events, the rest on clinical or video observation or clinical observation with concurrent EEG. The estimated prevalence from our 2 epilepsy centers is about 4 %. The abnormal non epileptic events were single motor, multiple motor and vocal tics in 70 % of the patients. Other events consisted on mannerisms, gratification disorder, and rhythmic movement disorders of sleep.  Conclusions: In patients with CAE the coexistence of non-epileptic movements is relatively common and a source of confusion in medication modification. The spectrum of presentation involves the awake state and the drowsy stages in some instances and can be a challenge for the clinician if the history taking is suboptimal especially in patients that are not monitored with EEG at the time of the motor manifestations. The prevalence of phone video taking has been a major breakthrough in recent years. Funding: None