Late-Onset Idiopathic Generalized Epilepsy Manifesting With De Novo Late-Onset Absence Status Epilepticus After COVID-19 Infection: A Case Report

Herein, we present a case of idiopathic generalized epilepsy (IGE) manifesting as de novo late-onset absence status epilepticus (ASE) following mild coronavirus disease 2019 (COVID-19). A woman in her 40s presented with persistent 3-5.5 Hz generalized spike-wave complexes (SWCs) on electroencephalography (EEG). She experienced a generalized tonic-clonic seizure (GTCS) 10 days after the COVID-19 infection. She was diagnosed with epilepsy at 40 years of age, after which she was started on levetiracetam (LEV) 1,000 mg/day. After the medication was started, she experienced three other GTCSs. We performed a long-term video EEG of the patient, leading to a diagnosis of late-onset IGE with de novo late-onset ASE. She achieved seizure freedom for over a year with a combination of valproic acid (VPA) and lamotrigine (LTG), although her EEG continued to demonstrate persistent generalized SWCs. This case suggests that late-onset IGE accompanied by de novo late-onset status epilepticus may have been triggered by COVID-19. Persistent neuroinflammation may be reflected in persistent EEG abnormalities, even after epileptic seizures are well controlled with medications. LTG and VPA are believed to be effective for clinical management, and EEG is an essential modality for recording epileptic activity in outpatient settings.