Sobre la dificultad diagnóstica de las ausencias en el adulto

Witness accounts of the characteristics of a convulsive seizure serve as the basis for the diagnosis, classification, and treatment of epileptic syndromes; however, no such account is available in many cases. In clinical practice, one-third of focal seizures with cognitive alterations are not controlled by antiepileptic drugs, with misdiagnosis remaining common. For this reason, video electroencephalography (EEG) monitoring is invaluable in the diagnosis, classification, and treatment of epilepsy. We present a case which demonstrates the potential difficulty of evaluating an adult patient with absence seizures, in which treatment and ‘‘resetting’’ the clinical history were a help in correctly diagnosing the condition and selecting an appropriate treatment. The patient was a 45-year-old man who was referred from another hospital, with no relevant family history; 15 years earlier, he had developed recurrent ‘‘disconnections’’ from his surroundings accompanied by occasional oral automatism, lasting approximately 5 seconds, during which posture was maintained. These episodes featured no associated sensory aura, dystonic posture, or tonic-clonic seizures and occurred approximately 4 times per day; the patient had no memory of the event. The physical examination revealed no pathological findings. Given the symptoms described, the patient was diagnosed with temporal lobe epilepsy (with complex partial seizures). A brain magnetic resonance imaging scan yielded normal results, as did a blood test with complete blood count; studies of liver function, iron metabolism, and kidney