Monthly Case

Since his 6^th year of life, a 14-year-old male adolescent patient suffers from multiple short (5 to 7 sec) periods with loss of contact. Former EEGs demonstrated generalized 3/sec spike-wave-complexes with maximal amplitude in frontal leads. Back then, the diagnosis of childhood absence epilepsy was made. When absence seizures manifest dozens of times per day, they are termed pyknoleptic absences or pyknolepsy. Some years ago, a US-american double-blind trial figured out that in childhood absence epilepsy ethosuximide still is the most efficient and best tolerated antiepileptic drugs (Glauser et al. 2010, New England Journal of Medicine). From onset of his epilepsy on, our patient was treated with ethosuxumide, absence seizures were well controlled.

At age 14 years, the question arose if the antiepileptic drug can be withdrawn. Childhood absence epilepsy has an excellent prognosis, with beginning of puberty the epileptogenicity markedly decreases. Even without antiepileptic drugs, patients do not suffer any more absences. The current patient and his family have not observed absence seizures for years. We performed a longterm-video-EEG-monitoring for 24 h and did not observe any clinical absence seizures nor any characteristic spike-wave patterns. It is highly likely that this patient will not have further seizures in the future.

This case nicely demonstrates the often benign course of childhood absence epilepsy which in most cases is – depending on age – self-limiting. Thus, in this subsyndrome of generalized genetic epilepsy antiepileptic drug withdrawal in the second decade of life is strongly recommended.

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