Status epilepticus manifested with absence and tonic seizures in an adult patient

Samples from video-EEG of status epilepticus manifested with absence and tonic seizures in a 48-year-old woman with unclassified idiopathic generalized epilepsy from the age of 11 years. She realized from previous experiences with similar lengthy events that she was in status epilepticus when she felt “weird, like in a trance, missing pieces of conversation,” and she went to the hospital. Despite written instruction, no diazepam was administered. She was alert, attentive, cooperative, and well behaved, but she seemed depressed. Movement and speech were normal. Video-EEG showed frequent, discontinuous, repetitive, and polymorphic generalized discharges of 2 types: (a) irregular 2 to 4 Hz spike/multiple spike and slow wave and (b) fast poly-spikes activity. She was able to count with no errors, but there was interruption or delay in counting during the generalized discharges (indicated by the numbers). Motor ictal symptoms occurred only during the paroxysmal rapid spikes and consisted of tonic eyes and mouth opening with backward head deviation. Video-EEG was recorded 7 hours from onset of symptoms, which ended with a generalized tonic-clonic seizure 1 hour later. Numbers indicate counting. (Contributed by Dr. C P Panayiotopoulos)