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'De novo' absence status of late onset

Report of 11 cases

From Service de Neurologie (Dr. Thomas and Pr. Chatel) and Service d'Explorations Fonctionnelle du Système Nerveux (Pr. Dolisi), Hôpital Pasteur, Nice, France; Division de Neurophysiologie Clinique (Dr. Beaumanoir), Hôpital Cantonnal et Universitaire de Genève, Switzerland; and Centre Saint Paul (Dr. Genton), Marseille, France.

Absence status (AS) is a heterogenous epileptic syndrome that can occur at any age, usually in a context of prior epilepsy. Eleven cases of AS occurring in middle-aged patients who had no history of epilepsy were retrospectively collected over a 10-year period (10 women and one man; mean age, 58.6 years). Eight patients were receiving high doses of psychotropic drugs. Clinical and EEG presentation was similar to AS occurring in patients with prior epilepsy. Evaluation of precipitating factors revealed that AS coincided with benzodiazepine withdrawal in eight cases. Cofactors included excessive use of other psychotropic drugs, nonpsychotropic treatment, hypocalcemia, hyponatremia, and chronic alcoholism. CT demonstrated mild cerebral atrophy in six cases. There was no recurrence, even without chronic antiepileptic treatment. These data indicate that (1) most cases of "de novo" AS of middle age or late onset result from the addition of various epileptogenic factors; (2) AS can be considered a new and uncommon complication of benzodiazepine withdrawal, and (3) long-term administration of anticonvulsant medication may not be required.

Address correspondence and reprint requests to Dr. P. Thomas, Service de Neurologie (Pr. M. Chatel), Hôpital Pasteur, 30 av. Voie Romaine, B.P. 69, 06002 Nice Cedex, France.

Presented in part at the second meeting of the European Neurology Society, Brighton, England, July 1989.

Received April 19, 1991. Accepted for publication in final form July 2, 1991.

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