Absence seizure

Question 1

Features

Answer 1

This type of generalised epilepsy

typically affects children from 4 yrs up to puberty.

It is subclassified as:

• childhood absence epilepsy (formerly known as petit mal), usually 4–9 yrs
• juvenile absence epilepsy usually 10–15 yrs.Child ceases activity and stares suddenly

Question 2

Symptoms

Answer 2

Child is motionless

No warning

Sometimes clonic (jerky) movement of eyelids, face, fingers

May be lip-smacking or chewing (called complex absence)

Only lasts a few seconds—usually 5–10 secs

Child then carries on as though nothing happened

Usually several per day (not just one or two)

May lead to generalised seizures in adulthood

Question 3

Diagnosis

Answer 3

Best evoked in the consulting room by hyperventilation.

EEG:

• Classic 3 Hz wave and spike
• May be normal
• Always include hyperventilation

Question 4

Medication

Answer 4

Ethosuximide (1st choice)

or

Sodium valproate (2nd choice):

• first line if associated other seizure type

Other choices: clonazepam, lamotrigine, clobazam

Question 5

Absence attack (petit mal)

Answer 5

Hospitalisation

IV diazepam