Refractory and Persistent Absence Epilepsy with Polyspikes in the Sleep EEG.
Abstract number :
2.097
Submission category :
Year :
2001
Submission ID :
2997
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
V.E. Villanueva, MD, Neurology, Fundacion Jimenez Diaz, Madrid, Spain; J.M. Serratosa, MD, PhD, Neurology, Fundacion Jimenez Diaz, Madrid, Spain
RATIONALE: To describe the clinical and electroencephalographic (EEG) characteristics of five adult patients with persistent and drug-resistant absence epilepsy.
METHODS: We reviewed a group of five patients with absence epilepsy (four with childhood onset and one with juvenile onset) with an unfavorable prognosis. All patients were followed in our Epilepsy Unit for a mean of three years and all had follow-up visits at least twice a year. A brain MRI and at least one prolonged video-EEG recording were performed for each patient.
RESULTS: The past medical history revealed the presence of complications during delivery in four patients. A family history of epilepsy was present in two patients. Psychomotor development was normal in all patients. The mean age at onset of seizures was 8.8 years (range 3-15 years). All patients presented absence and generalized tonic-clonic seizures and one associated myoclonic seizures. All seizure types present in each patient persisted throughout adulthood despite adequate treatment with antiepileptic drugs. MRI was normal in all patients with the exception of patient 3 who presented diffuse brain atrophy. The interictal awake EEG activity consisted of an alpha rhythm intermixed with slow waves and spike-wave and polyspike-wave discharges in all patients. Absences varied from very brief episodes of disconnection to prolonged episodes sometimes leading to generalized tonic-clonic seizures. Automatisms were rare. Ictal EEG activity consisted of 3-4 Hz polyspike-wave discharges. Sleep EEG recordings were characterized by frequent, diffuse polyspike discharges that were more prominent during stages I and II. These polyspike discharges were not present in our patients with non-refractory absence epilepsy. We did not find fast rhythmic discharges at 10-15 Hz as described by Guye et al (Epilepsia 2001; 42:351-356).
CONCLUSIONS: Among the absence epilepsies there is a group of refractory patients with persisting seizures throughout adulthood and atypical EEG features. Frequent polyspike discharges during the first stages of sleep are characteristic. A history of perinatal brain damage was common suggesting that these patients represent an [dsquote]intermediary[dsquote] absence epilepsy between the idiopathic and symptomatic epilepsies