Atypical Clinical Course of a Very Late Onset Generalized Epilepsy Syndrome
Abstract number :
3.123
Submission category :
18. Case Studies
Year :
2025
Submission ID :
45
Source :
www.aesnet.org
Presentation date :
12/8/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Emily Nguyen, BS – University of Oklahoma Health Science Center
BHRUGAV RAVAL, MD – University of Oklahoma Health Science Center/OU Health
Rationale: Late-onset generalized epilepsy with episodes of status epilepticus is a rare diagnosis. Idiopathic generalized epilepsies typically present in childhood or adolescence, making new diagnoses in older adults uncommon. The most common etiologies of late-onset epilepsy include secondary causes, including cerebrovascular disease, structural brain lesion, metabolic causes and rarely autoimmune conditions. This case highlights an unusual presentation of late-onset generalized epilepsy with a unique clinical course.
Methods: We present the case of a 68-year-old woman with a diagnosis of late-onset generalized epilepsy, complicated by recurrent episodes of status epilepticus. Her initial seizure episode occurred in 2007 at the age of 51. At that time, brain magnetic resonance imaging (MRI) was unremarkable; however, electroencephalography (EEG) demonstrated 4 Hz generalized spike-and-wave discharges, consistent with a generalized epilepsy syndrome. She was started on lamotrigine, which effectively controlled her seizures for over a decade. In 2020, the patient began experiencing more frequent and atypical seizure episodes. In May 2020, she presented with a prolonged episode of catatonia and confusion lasting approximately 24 hours. Levetiracetam was subsequently added to her regimen. In May 2021, she was hospitalized for COVID-19 pneumonia and developed new-onset speech disturbances and facial asymmetry, raising concern for an acute cerebrovascular event. However, repeat brain MRI revealed no acute findings. The levetiracetam dose was increased at that time. In August 2021, shortly after receiving bilateral intra-articular steroid injections in the knees, the patient again developed confusion and expressive language difficulties. A further increase in her levetiracetam dose was made. She was evaluated once more in November 2021 for similar symptoms of confusion and catatonia, which showed marked improvement following intravenous administration of lorazepam. After the dosage increases of levetiracetam and lamotrigine, seizure control was adequate. A home EEG study in October 2023 showed frequent paroxysms of generalized spike-wave discharges. She experienced significant improvement after increasing doses of levetiracetam and lamotrigine, without any recurrence of status epilepticus.
Results: Recurrent episodes of confusion/catatonia, with speech disturbances likely represent clinical absence status epilepticus. This was possibly triggered by stressors including illness and sleep deprivation. Effective management required careful medication adjustments and identification of seizure triggers.
Conclusions: This case highlights a very rare presentation of a primary generalized epilepsy syndrome, specifically an extreme late-onset epilepsy and recurrent episodes of absence status epilepticus, after a sustained period of seizure freedom.
Funding: Departmental Funding
Case Studies