Typical absence status epilepticus in older people: syndromic delineation

Abstract

Objective. We describe the clinical, electroencephalographic and neuroimaging findings of older patients with typical absence status epilepticus (ASE). Methods. This investigation was a retrospective analysis of prospectively collected consecutive patients between January 2011 and October 2021. All rhythmic, synchronous and symmetric epileptiform discharges and normal background on video‐electroencephalogram (vEEG) were included. Results. Six patients were identified with a diagnosis of typical ASE. The mean age was 67 years. Five could be classified as idiopathic generalized epilepsy (IGE) though two had been erroneously categorized as cryptogenic focal epilepsy (FE). In one, the episode of ASE was thought to represent the beginning of late‐onset IGE (de novo late‐onset typical ASE). In all cases, ASE was controlled within the first 24 hours. Significance. Typical ASE is a rare cause of confusion in the elderly population requiring urgent vEEG evaluation. It most frequently represents reactivation of a previous IGE, although it can be the form of presentation in elderly people with epilepsy that begins in childhood or adolescence and that has not been diagnosed or treated. It may be rarely the debut of (de novo) late‐onset IGE.

Typical Absence Status Epilepticus in Later Life Precipitated by Spirometry

“…It most frequently represents reactivation of a previous genetic generalized epilepsy (GGE), although it may also represent a form of presentation in elderly people with epilepsy that begins in childhood or adolescence and that has not been diagnosed or treated. 1 Most rarely, it may be the presentation de novo of late-onset GGE. [1][2][3] A 65-year-old man with chronic pulmonary obstructive disease undergoing evaluation for lung transplantation came to our hospital for pulmonary function tests.…”

“…1 Most rarely, it may be the presentation de novo of late-onset GGE. [1][2][3] A 65-year-old man with chronic pulmonary obstructive disease undergoing evaluation for lung transplantation came to our hospital for pulmonary function tests. During the spirometry, the patient had a sudden episode of loss of consciousness with a fall to the ground and tonic contraction of the body and the four extremities without myoclonic jerks or other abnormal movements.…”

“…Of note, five patients (one in this cohort and four in the literature) had an initial presentation of typical ASE. 1,4 Most frequently, in older people, the occurrence of typical ASE represents an aggravation or reactivation of a known pre-existing GGE. 1 Often, these patients have been seizure-free for years and may suffer from episodes of altered mental status secondary to typical ASE when they reach an older age.…”

“…1,4 Most frequently, in older people, the occurrence of typical ASE represents an aggravation or reactivation of a known pre-existing GGE. 1 Often, these patients have been seizure-free for years and may suffer from episodes of altered mental status secondary to typical ASE when they reach an older age. Later life could represent a period of vulnerability associated with predisposing factors including chronic ischemia, white matter disease, cerebral atrophy, metabolic derangements, hormonal changes, and polypharmacy in patients with GGE.…”

“…In a previous study, four of six patients had small vessel brain disease and/or cortical-subcortical atrophy on neuroimaging studies. 1 Indeed, some authors have suggested that the increase in cerebrovascular lesion burden can alter cortical excitability and lower seizure threshold in patients with a genetic predisposition. 3 In the case of an elderly patient with no history of epilepsy who has new onset of an ASE episode, the first option would be to consider de novo ASE of late onset (dnASLO).…”