Idiopathic generalised epilepsy in adults manifested by phantom absences, generalised tonic-clonic seizures, and frequent absence status

Objectives-To describe the clinical and EEG features of adult patients with very mild absences, late onset generalised tonic clonic seizures, and frequent absence status. Methods-Patients were referrals to a clinic. for epilepsies. They all had clinical assessment and EEG, video EEG, or both for documentation of absences. Results-Of 86 adults with idiopathic generalised epilepsies and EEG/video-EEG documented absences, 13 patients showed similar clinico-EEG features with: (a) ''phantom absences'' consisting of mild ictal impairment of cognition associated with brief (3-4s), generalised 3-4 Hz spike/multiple spike and slow wave discharges; (b) infrequent, mainly late onset, generalised tonic clonic seizures, and (c), absence status which occurred in six of them either in isolation or terminating with generalised tonic clonic seizures. None of the patients had myoclonic jerks or photosensitivity. Two patients were father and daughter and another patient had a family history of infrequent generalised tonic clonic seizures. Conclusion-It seems that this is an idiopathic generalised epilepsy syndrome in adults which has not been previously recognised.