Abstracts

Rationale: Alteration of consciousness and attention can show wide degrees of heterogeny between patients with absence seizures thought to be due to similar generalized epilepsy syndromes. Atypical electroclinical characteristics are associated with refractoriness to AEDs and persistence into adulthood. We describe three adult patients with frequent and prolonged generalized epileptiform discharges and absence seizures with different manifestations of seizure occurrence and alteration of consciousness. Methods: Three adult patients with recurrent absence status as predominant seizure type and prolonged runs of generalized epileptiform discharges during VEEG were identified. Seizure characteristics and frequency, EEG features as well as response to drug therapy were reviewed. Results: Patient 1 had absence seizures for one year as a child which responded to treatment but recurred at 50 years and are currently refractory. Patient 2 who developed seizures later in life experiences bouts of absence status terminating in convulsions at no other time but once per year. Patient 3 with adult onset epilepsy has ictal patterns of generalized delta and theta and some focal features on EEG. His complaints are of epsiodic amnesia as his main symptom with evidence of ability to complete battery of complex neuropsychological tasks during prolonged ictal periods documented by VEEG. Conclusions: Lack of correlation between epileptiform patterns on EEG, altered awareness and seizure rates in these adult patients is further evidence of the heterogenous nature of generalized epilepsy syndromes with absence seizures. Detailed neurophysiological and hemodynamic imaging studies into absence seizures in these older patients may provide further insight into the pathophysiology of intractability and persistence into later life.