title: Unilateral continuous subclinical paroxysmal activity: an unusual finding in a patient with recurrent absence status.
abstract: We report a patient with a history of rare generalised tonic-clonic seizures and recurrent absence status who was diagnosed with a rare variant of idiopathic generalised epilepsy and absence status epilepsy. No other pathology was identified and MRI was normal. During a follow-up of 17 years, we recorded a single unilateral continuous, strictly subclinical, paroxysmal activity which lasted for at least several hours. No control was observed under treatment with phenobarbital, lamotrigine and topiramate. Absence status was aggravated with carbamazepine and generalised tonic-clonic seizures were not controlled with ethosuximide. Total seizure control was only possible with sodium valproate, which caused weight gain, and the patient has remained seizure-free for the past 10 years under 1,000 mg/d valproate and 200 mg/d topiramate. The recorded unilateral, long-lasting, subclinical spike-and-wave discharge is quite unusual for idiopathic generalised epilepsy and, in our opinion, occupies a transitional position between generalised and focal activity.
authors.affiliation: Centre Saint-Paul, Marseille, Hôpital Gui de Chauliac, Montpellier, France. velizarova.reana25@gmail.com
authors.forename: Reana
authors.initials: R
authors.lastname: Velizarova
authors.forename: Pierre
authors.initials: P
authors.lastname: Genton
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects*; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D002220:Carbamazepine / Q000008:administration & dosage / Q000009:adverse effects; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography; D004830:Epilepsy, Tonic-Clonic / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D000077213:Lamotrigine; D010634:Phenobarbital / Q000008:administration & dosage / Q000009:adverse effects; D055502:Secondary Prevention; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D000077236:Topiramate; D016896:Treatment Outcome; D014227:Triazines / Q000008:administration & dosage / Q000009:adverse effects; D014635:Valproic Acid / Q000008:administration & dosage / Q000009:adverse effects; D015430:Weight Gain / Q000187:drug effects
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D000077236:Topiramate; D005632:Fructose; D002220:Carbamazepine; D014635:Valproic Acid; D000077213:Lamotrigine; D010634:Phenobarbital