How should we manage adult patients who present with an absence status? A study of case series

Abstract

Backgrond & Objective: Absence status epilepticus (ASE) is a generalized, prolonged absence seizure that can persist for hours or even days. In adults, it is often misdiagnosed or overlooked, frequently mistaken for focal impaired consciousness non-convulsive status epilepticus or, particularly in the elderly, for confusional episodes related to cerebrovascular disorders. In this study, we retrospectively analyzed adult patients with absence status, considering their clinical and electrophysiological characteristics, as well as their prognosis.

Methods: We reviewed hospital records from 2002 to 2023 to analyze clinical symptoms, ictal and interictal electroencephalography (EEG) findings, blood test results, cranial imaging, and treatment approaches in adult patients with absence status at our clinic.

Results: Five cases were identified as exhibiting ASE. The mean age at the first ASE episode was 48 years. The primary clinical symptom during ASE episodes was varying degrees of confusion. Ictal EEG findings were consistent with typical absence status. Three patients had a prior diagnosis of genetic generalized epilepsy before developing ASE, while two patients were diagnosed with ASE following recurrent ASE episodes. The main triggering factors included noncompliance with anti- seizure medications (ASMs), inappropriate ASMs, and lithium therapy. Valproate and levetiracetam were effective in terminating ASE episodes.

Conclusion: This study presents the clinical and electrophysiological findings of ASE in adults and evaluates prognosis with feasible treatment approaches.