Epigastric sensations as an unusual manifestation of adult absence epilepsy

We report the case of a 39-year-old woman with onset of daily epigastric se nsations associated with brief episodes of unresponsive blank stare, which have been interpreted as complex partial seizures with occasional secondary generalisation. Phenytoin as monotherapy and in combination with valproate had not been effective. During video-EEG we recorded typical absences with brief 3 second spike, and slow-wave discharges of up to 5 seconds, which w ere recognized by the patient herself. All absences were preceded by epigas tric sensations. There was no indication of focal epilepsy. Monotherapy wit h valproate substantially decreased the frequency of the absences. In concl usion, this case is peculiar for several reasons: 1) late onset of absence epilepsy 2) epigastric sensation at onset of absence seizures, 3) recogniti on of brief "phantom" absences and 4) presumable adverse effects of phenyto in.