Typical absence status epilepticus in older people: syndromic delineation

Objective. We describe the clinical, electroencephalographic and neuroimaging findings of older patients with typical absence status epilepticus (ASE). Methods. This investigation was a retrospective analysis of prospectively collected consecutive patients between January 2011 and October 2021. All rhythmic, synchronous and symmetric epileptiform discharges and normal background on video‐electroencephalogram (vEEG) were included. Results. Six patients were identified with a diagnosis of typical ASE. The mean age was 67 years. Five could be classified as idiopathic generalized epilepsy (IGE) though two had been erroneously categorized as cryptogenic focal epilepsy (FE). In one, the episode of ASE was thought to represent the beginning of late‐onset IGE (de novo late‐onset typical ASE). In all cases, ASE was controlled within the first 24 hours. Significance. Typical ASE is a rare cause of confusion in the elderly population requiring urgent vEEG evaluation. It most frequently represents reactivation of a previous IGE, although it can be the form of presentation in elderly people with epilepsy that begins in childhood or adolescence and that has not been diagnosed or treated. It may be rarely the debut of (de novo) late‐onset IGE.