Abstracts

Rationale: The classification of Idiopathic Generalized Epilepsy (IGE) in adults has been one of the most debated issues. Absence seizures in adults are not recognized by International League Against Epilepsy (ILAE) which recommend to classify this kind of seizure only for children. Absence seizures usually have their onset during the childhood (from 4 to 8 years old) and the adolescence (from 9 to 13 years old) in some idiopathic syndromes as Childhood Absence Epilepsy (CAE) and Juvenile Absence Epilepsy (JAE), respectively. They are characterized by its sudden onset, interruption of the ongoing activities, staring and brief eyes upward rotation which can last few seconds. EEG shows 3 Hz generalized spike-wave discharges in childhood (CAE) and in youngsters (JAE) generalized spike or polyspike-wave discharges but with a slightly faster repetition rate (3-4 Hz) synchronic, bilateral and symmetric. In adults IGE are usually misdiagnosed or even classified and treated as partial complex seizure and also as a behavior disturb. Video-EEG is a powerful tool which allows performing a better diagnosis for syndromes that usually are confounded with other epilepsies. Our purpose is to present a set of evidences for absence seizure in adults epileptic patients obtained from video-EEG analyses. Methods: Thirty-seven outpatients fulfilled inclusion criterion for typical absence seizure according ILAE (16 male and 21 female), ages between 16 years old and 48 years old (mean: 29.9 years) were selected from an Epilepsy Service for a continuous 48 hours video-EEG and their clinical story were taken. Recordings were subjected to visual analysis for seizure frequency and classification. Results: 48.65% presented family story of epilepsy. 86.5% denied febrile seizures during childhood. Seizures onset was between 6 months to 21 years old (median=12y), 54% onset in adolescent period (9 to 18 y according Panayiotopoulus). Seizure features are typical absence 16.22% patients; absence and tonic 5.41%; absence and generalized tonic clonic 40.54%; absence with generalized tonic clonic and myoclonia 13.51%; absence and myoclonia 21.62% and finally without seizures during video-EEG 2.7%. 14 patients presented 3 Hz spike-waves discharge; 21 patients presented 3-4 Hz spike-wave or poly spike-wave; 1 patient presented 1-2 Hz spike-wave and 1 patient presented 2.5 Hz without any kind of cognitive impairment. MRI does not show abnormality in 35 patients. Conclusions: The absence seizures are seldom described in adults patients. They are frequently misdiagnosed and treated as a partial complex seizure and also as a behavior disturb. Video-EEG and clinic diagnosis can avoid an unnecessary investigation and allow a good follow up for the patient.