De novo absence status of late onset following withdrawal of lorazepam: a case report

The aim of this report is to describe the clinical and electroencephalographic findings seen in an elderly woman without previous history of seizures who developed a nonconvulsive generalized status epilepticus following acute withdrawal of lorazepam. Scalp video-EEG monitoring was obtained using the standard 10/20 system of electrode placement. Cognitive and speech functions were specifically tested during the evaluation. Continuous irregular rhythmic generalized 2.0-2.5 Hz sharp-and-slow wave complexes intermixed with spikes and polyspikes more prominent over the frontocentral areas were seen on the EEG. This epileptic activity was continuous and unmodified by sensory stimulation and eyes opening and closing. Intravenous injection of diazepam caused a rapid normalization of the EEG with disappearance of the clinical manifestations. De novo absence status is a specific epileptic condition that should be suspected in all elderly subjects on chronic treatment with psychotropic drugs presenting in a confusional state. An urgent EEG is essential to confirm the diagnosis.