Absence status epilepticus in IGE with phantom absences (1)

(Top) Video-EEG prior to diazepam. There was continuous spike and occasional polyspike-and-slow wave activity mainly at 3 Hz that lasted until the administration of diazepam. Note also slower or faster components and some topographic variability of the discharge. The patient was fully alert, attentive, and cooperative. Movements and speech were normal. There were no abnormal ictal symptoms other than severe global memory deficit and global diminution of content of consciousness. She was unable to remember her name, how many children she had, the current date, and her location. She could not perform simple calculations but could repeat up to five numbers given to her. She could read text correctly, and she wrote her address correctly, although she could not remember it on verbal questioning. She did not know where she was, but given the choice between various locations, she correctly recognized that she was in the hospital. (Bottom) Relative normalization of the EEG started within a minute from onset of diazepam administration, and the patient was able to say the correct date, her address, the name of the hospital, how many children she had, and her name. Note in the EEG the fragmentation of the discharge and the reappearance of alpha rhythm. She continued having problems with calculations, and there were still some memory disturbances even after the intravenous administration of another 5 mg of diazepam and 400 mg of sodium valproate. However, she was sufficiently well to be allowed to leave the hospital with her husband, and she recovered completely at home. (Contributed by Dr. C P Panayiotopoulos.)