Division of EEG and Epileptology, Department of Neurology, Inselspital, University Hospital of Berne, CH-3010 Berne, Switzerland.
We report the case of a 39-year-old woman with onset of daily epigastric sensations associated with brief episodes of unresponsive blank stare, which have been interpreted as complex partial seizures with occasional secondary generalisation. Phenytoin as monotherapy and in combination with valproate had not been effective. During video-EEG we recorded typical absences with brief 3 second spike, and slow-wave discharges of up to 5 seconds, which were recognized by the patient herself. All absences were preceded by epigastric sensations. There was no indication of focal epilepsy. Monotherapy with valproate substantially decreased the frequency of the absences. In conclusion, this case is peculiar for several reasons: 1) late onset of absence epilepsy, 2) epigastric sensation at onset of absence seizures, 3) recognition of brief "phantom" absences and 4) presumable adverse effects of phenytoin.Epigastric auras, impaired consciousness and automatisms are typical symptoms of temporal lobe epilepsy . We present the unusual clinical course, EEG and video recording of a 39-year-old woman with late onset absence epilepsy. The absences manifested with epigastric sensations and hand automatisms and were misdiagnosed as temporal lobe epilepsy.