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Absences in seizure-free patient with juvenile myoclonic epilepsy

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This 28-year-old woman with juvenile myoclonic epilepsy was referred for a routine EEG because of a recent, first-ever GTCS after sleep deprivation. She had absences from the age of 9 years and myoclonic jerks from her early teens. Valproate treatment was withdrawn at age 18 years because she was assessed as seizure-free. However, the video-EEG documented that she still had brief absences, which manifested with mild impairment of cognition and eyelid jerks. These were spontaneous or induced by (A) hyperventilation and (B) intermittent photic stimulation. Note the polyspike-wave of the discharges and the irregular intradischarge frequency (C). Also note the bifrontal spike-slow wave discharges (A, red arrows). (Used with permission from: Panayiotopoulos CP. Reflex seizures and related epileptic syndromes: a clinical guide to epileptic syndromes and their treatment. Revised 2nd ed. London: Springer, 2010:497-531.)