ICNC Abstracts, ICNC 2018

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Absence epilepsy, the great masquerader
Samata Singhi

Last modified: 2018-09-09


Introduction: We present an interesting case in whom staring spells asociated with psychocial stressors were presumed to be non-epileptic, and the diagnosis of absence epilepsy was delayed for 13 years.

Case Description: An 18 year-old female presented with a history of brief episodes of unresponsiveness/ blanking out/ staring with occasional head bobbing and blinking starting at the age of 5. These episodes were associated with major stresses and were presumed to be psychogenic. Routine EEGs were normal. In 2014 she had a prolonged episode of blinking and head bobbing after an acute stress. An emergent EEG was again normal. The episodes continued and in 2017 long term video EEG monitoring was done. No discharges or seizures were captured for the first 3 hours; however, after taht 73 seizures characterzied by behavioral arrest/ rapid blinking or head bobbing were recorded over 3 days. EEG showed bursts of ictal and interictal 3HZ spike and wave generalized discharges potentiated in sleep and with hyperventilation. A diagnosis of juvenile absence epilepsy was made. Soon after, she had her first tonic clonic seizure. She was given Depakote and later lamotrigine.

Conclusions: This case highlights that 1) clinical suspicion for absence seizures should be maintained in a child with staring and unresponsiveness even if events are associated with psychosocial stress since stress often exacerbates epilepsy, 2) routine EEGsmay not always be abnormal in absence epilepsy, and long term video EEG may be needed and 3) events must be characterized on EEG before labelling them "psychogenic."


absence epilepsy

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