[Generalized idiopathic epilepsy with refractory absence seizures in the adult]

The prognosis for generalized epilepsy with absence seizures starting in childhood and adolescence (GEA) must be given cautiously because of the possibility that seizures may persist into adulthood and occur along with tonic-clonic seizures. Such an unfavorable course may be due to factors that are intrinsic to the various epileptic syndromes involving absences and/or to individual patient characteristics. An additional factor of particular importance in GEA is inadequate treatment. We describe 15 adult patients with GEA whose mean age when examined was 41.3 years. All had experienced absence seizures since childhood and 12 had had convulsive seizures. Most were following haphazardly combined therapies. An average of 4 years was needed to modify treatment and achieve remission of seizures in 11 of the 13 cases followed for more than 1 year. We emphasize the efficacy of valproate (in 14 of 15 patients) and its combination with ethosuximide (4 patients). GEA should not be considered refractory until appropriate use of these drugs has been tried; rather it is a syndrome that may go into remission even after decades of persistent seizures.