Juvenile myoclonic epilepsy in an elderly patient

Juvenile myoclonic epilepsy constitutes 5-10% of idiopathic generalised epileptic syndromes. The clinical triad of absence seizures, myoclonic jerks and generalised tonic clonic seizures (GTCS) rarely begin after the second decade of life. We present the case of a 74-year-old lady presenting for the first time with myoclonic jerks and absences. The electro encephalogram revealed generalised polyspike and wave epileptiform activity with photosensitivity. On close questioning, she appeared to have had a single episode of GTCS at the age of 10. She remained asymptomatic for 64 years before the diagnosis was made. Although rare, idiopathic myoclonic epilepsy could remain asymptomatic for decades and can present in the elderly. Proper classification of this epileptic syndrome, even in the elderly, is essential in view of the response to appropriate antiepileptic therapy.