Abstracts

Rationale: A small percentage of patients with absence epilepsy do not respond to conventional medical therapy. Recently it was reported that newer antiepileptic medications might be a useful alternative. We present patients from our practice that failed to respond to some of the newer antiepileptic medications. Methods: Case series.Results: Nine patients (3 boys and 6 girls) were found not to respond to conventional therapy with ethosuxsimide and valproate. Patients were consequently placed on 3 to 8 different antiepileptic medications (levatiracetam-six patients, topiramate and lamotrigine four, zonisamide and klonopin three, phenytoin and phenobarbital two and oxcarbazepine, clobazam, primidone, gabapentin carbamazepine – one). Onset of seizures was between the ages of 2 and 8 years old. Three patients had at least one generalized tonic clonic seizure in their lifetime but absence was the predominant seizure type. One patient had occasional non-epileptic seizures characterized by unresponsiveness. EEG findings in all patients showed 3Hz generalized spike and wave with normal background. One patient had bilateral centro-temporal spikes during sleep on initial VEEG that were not present on the following VEEG monitoring. Three patients had a family history of seizures. Three patients had history of febrile seizures. Family reported behavioral problems (agitation, irritability) in three patients. Three patients had language delays. Atypical clinical features were reported in three patients (neck hyperextension, “yawning” vocalization and facial hypotonia). No clear predisposing factors were identified in patients with medically refractory absence. Quality of life was significantly affected in all patients.Conclusions: Childhood absence epilepsy is usually considered a benign syndrome since seizures usually respond well to monotherapy. We report cases that remained refractory to a number of antiepileptic medications from the initiation of the treatment. No clear predisposing factors were identified.