Abstracts

Rationale: Absence status epilepticus (ASE) has been reported in patients with and without history of generalized epilepsy, with distinctive EEG patterns of generalized spike-and-wave activity. Patients usually present with altered mental status and non-specific symptoms that resolve after appropriate treatment with anti-epileptic drugs. We report 2 cases - one with Steroid Responsive Encephalopathy associated with Autoimmune Thyroiditis (SREAT) and the other with Secondary Progressive MS (SPMS) presenting with ASE and atypical EEG pattern. Methods: 2 Case reports.Results: -Case 1: A 29-year-old man with a 2yr history of SREAT and Convulsive status epilepticus (CSE) was admitted for confusion, jerky limb movements and muscle twitches. On the day of admission, he was found to have elevated antithyroid antibodies and his EEG showed medium to high voltage generalized frontally predominant sharply contoured theta activity (Figure 1). His maintenance levetiracetam dose was increased from 1000 mg po bid to 2000 mg twice a day and valproic acid was added at a dose of 1000 mg po twice daily. He also received solumedrol 1000 mg IV daily for five days. A complete clinical and electrographic recovery occurred within 24 hours of treatment. -Case 2: A 42-year-old woman with history of SPMS was admitted for confusion and short-term memory loss. She had prior hospital admissions for similar symptoms and no clear etiology was found. On exam she was not oriented to person & place and also had word finding difficulty. CT brain was negative. Her EEG recorded a high voltage generalized sharply contoured theta activity (Figure 2). Atypical generalized absence status epilepticus was suspected. She was treated with levetiracetam 500 mg po bid and within 24hrs she was back to her normal self with normalization of the EEG activity. Conclusions: ASE may be associated with an atypical pattern of high voltage generalized frontally dominant sharp theta activity, without clear spike-and-wave activity Prompt clinical and electrographic recovery follows treatment with antiepileptic drugs appropriate for generalized absence.