Monthly Case

A 67-year old female patient presents in one of our epilepsy outpatient clinics accompanied by her daughter. The patient reports that since her early school age, i.e. since her 9th year of life, absence seizures have occurred several times per day. Five years later, she suffered her first tonic clonic generalized epileptic seizure. Only at that time point, the correct diagnosis of epilepsy has been made, treatment was initiated with ethosuximide.

One or two years later, the antiepileptic drug was withdrawn, since then the patient has been off medication. The patient and her daughter report that epilepsy in the patient’s primary family, i.e. by her parents and her siblings, has been completely hushed up. Epilepsy was highly disregarded and eventually denied in that family. The daughter later noticed that the patient had recurrent short episodes with unresponsiveness; however, the patient refused to contact a neurologist.

After manifestation of concentration difficulties, the patient eventually presented in our epilepsy outpatient clinic. EEG immediately revealed frequent spike-wave-complexes at 2-3/s lasting up to 3 s. Based on the history and the unequivocal EEG finding, the diagnosis of childhood absence epilepsy was made.

Treatment with 900 mg valproic acid resulted in occurrence of very rare absence seizures, the corresponding EEG showed some single spike-wave-complexes only.

In summary, this case shows on the one hand that epilepsy – in particular in elderly patients – can still be heavily stigmatized. On the other hand, even after hundred thousands of absence seizures, immediate pharmacoresponsiveness is still preserved.

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