Absence status epilepticus in IGE with phantom absences (2)

(Top) EEG of absence status and (bottom) interictal video EEG with phantom absences of a woman who had her first absence status epilepticus followed by a generalized clonic-tonic seizure at the age of 56 years. Initially, we erroneously classified her as de novo absence status epilepticus instead of idiopathic generalized epilepsy with phantom absences. This mistake became apparent when interictal video-EEG demonstrated absences manifested with mild cognitive impairment and eyelid fluttering (bottom). In reviewing this video-EEG with the patient and her daughter, they recognized that these mild absences were occurring many years prior to the absence status epilepticus. Note the similarity between the EEG discharge of absence status epilepticus (top) and typical absence seizure (bottom). (Contributed by Dr. C P Panayiotopoulos.)