{
 "topic": "Absence Seizure",
 "slug": "absence-seizure",
 "category_id": 15023,
 "passage_count": 14,
 "source_chars": 12358,
 "enough_material": true,
 "references": [
  {
   "title": "MedStudy Pediatrics Core 11th Edition 2024-2025",
   "author": null,
   "pages": [
    456
   ]
  },
  {
   "title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
   "author": null,
   "pages": [
    489
   ]
  },
  {
   "title": "Update in Pediatrics",
   "author": null,
   "pages": [
    576
   ]
  },
  {
   "title": "Berkowitz's Pediatrics",
   "author": "Berkowitz, Carol D.;",
   "pages": [
    1004,
    1006,
    1009
   ]
  },
  {
   "title": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online",
   "author": null,
   "pages": [
    638,
    639
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    3636
   ]
  }
 ],
 "passages": [
  {
   "source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 456",
   "text": "* Skin-color changes * Tachycardia Atypical absence seizures are not associated with auras, hallucinations, or postictal abnormalities. Absence seizures can be confused with focal seizures with impaired awareness, but focal seizures often last longer (usually > 30 seconds), have auras, and have slow return to awareness postictally. Absence seizures most commonly are seen with childhood absence epilepsy, which occurs in children 4-12 years of age. These seizures can occur many times in a day. Occasionally, the staring is unnoticed. Sometimes the child presents with symptoms of attention-deficit/hyper- activity disorder (ADHD) or with scholastic difficulties. Hyperventilation for 3-4 minutes usually provokes an absence seizure; do this routinely during EEG to help make this diagnosis. EEG shows a characteristic 3-Hz generalized spike and wave discharge. Those affected have normal intelligence and normal neurologic examination. Treat with ethosuximide. Alternatives include valproate or lamotrigine. Note that"
  },
  {
   "source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 489",
   "text": "Absence seizures are brief episodes of impaired consciousness with no aura or postictal confusion. They typically last less than 20 seconds and are accompanied by few or no automatisms. Hyperventilation or photic stimulation often precipitates these seizures, which typically begin during childhood or adolescence, although they may persist into adulthood. In children, these seizures may initially go unnoticed and are often associated with decreased school performance or poor attention. The classic ictal electroencephalographic (EEG) correlate of absence seizures consists of 3-Hz generalized spike and slow-wave complexes (Figure 74-3). ## FEBRILE SEIZURES"
  },
  {
   "source": "Update in Pediatrics, p. 576",
   "text": "The age of onset is around 5\u20136 years of age (4\u201310 years). CAE accounts for 8\u201315% of all childhood epilepsies. 23 Update in Pediatric Neurology 593 ## **Seizure Semiology** Typical absence seizures are described as brief (4\u201320 s), periods of loss of awareness, that can occur frequently through the day (10 to >100 day[\u2212][1] ), with an abrupt \u201conset and offset\u201d. There is no postictal state and the child resumes his/her activity immediately after the absence seizure. Other associated ictal findings include the following: rapid eye blinking; lip smacking and twitching of the eyelids, eyebrows or mouth; simple motor and/or oroalimentary automatisms (in up to two-thirds of cases); and incontinence (unusual). At times slumping of posture may be seen due to a reduction in axial muscle tone, but falls associated with atonic seizures do not occur in CAE and if present the patient should be referred to a pediatric neurologist. Around 35% of these children may present with one generalized tonic-clonic seizure."
  },
  {
   "source": "Berkowitz's Pediatrics, p. 1009",
   "text": "Children and those around them are sometimes unaware of the occurrence of absence seizures. Often, an observant teacher brings the child\u2019s problem to a physician\u2019s attention. During a spell, a child has no change in tone or clonic movements and may have only subtle facial or hand movements. The episode lasts only a few seconds, and there are no preictal or postictal behaviors. Historical information can also help determine potential etiologies of the seizure problem. A known distant brain insult or a hereditary disposition or consanguinity may be related to the cause. The patient with progressive loss of skills should be evaluated for a degenerative disease. Many degenerative conditions can masquerade as epilepsy, and the physician must be continuously aware of progressive loss of vision, hearing, coordination, strength, or cognition as clues to initiate a more comprehensive workup. ## **Physical Examination**"
  },
  {
   "source": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online, p. 638",
   "text": "generalize to contralateral brain areas, with loss of consciousness, often with bilateral convulsive features. _Generalized seizures_ may be convulsive or nonconvulsive in nature. In children, nonconvulsive generalized seizures often present as absence epilepsy. Other generalized seizures such as tonic, tonic\u2013clonic, atonic, and myoclonic are defined by the type of motor activity observed. _Absence seizures_ are typically brief in duration (5 to 20 seconds) and are characterized by sudden staring or arrest of activity with abrupt recovery. They are often associated with facial automatisms such as eye flutter, chewing, or ocular supraversion (Fig. 15-67). The incidence of absence epilepsy peaks in children between the ages of 3 and 8 years; however, onset can occur in adolescence. The disorder has a strong genetic predisposition and usually occurs in children who are Table 15-9 Classification of Epileptic Seizures ![](/tmp/pdf-images/pdf-0638-08.png)"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Seizures are the clinical expression of abnormal, excessive, synchronous discharges of neurons residing primarily in the cerebral cortex. This paroxysmal activity is intermittent and its duration may last from a few seconds to many hours. Seizures represent a neurologic emergency either due to the underlying cause (e.g., bleed, infection) or the potential for neuronal death as a result of a prolonged seizure. Approximately 5% of children will have at least one seizure in the first 16 years of life. The immature brain, particularly in the neonate and young infant, differs from the adult brain in the basic mechanisms of epileptogenesis and propagation of seizures. It is more prone to seizures, but seizures are also more apt to disappear as the child grows. Physicians must have a fundamental knowledge of seizure classification (semiology), all aspects of seizure management (including initial stabilization), determination of cause (differential diagnosis), appropriate definitive treatment, and patient"
  },
  {
   "source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 456",
   "text": "Alternatives include valproate or lamotrigine. Note that carbamazepine can worsen absence seizures. Prognosis is excellent and > 90% of patients become seizure free with treatment. Remission occurs by 12 years of age. Atonic or Akinetic Seizures An atonic seizure (a.k.a. drop attack) has the following characteristics: * Sudden and complete loss of tone in the limbs, neck, and trunk muscles (without warning) * Typically brief in duration * Loss of awareness * Complete awareness returning very quickly after the attack * 1 or more myoclonic jerks sometimes occurring immediately before muscle tone is lost Atonic seizures are more common in children with epi- leptic encephalopathies (e.g., Lennox-Gastaut syndrome) and are frequently difficult to treat. FOCAL SEIZURES Occurrence Focal seizures are less common in children than adults but still make up 40-45% of childhood seizures. Children rarely have a definable \u201cfocal\u201d lesion responsible for their focal seizure and many children have normal neuroimaging."
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 3636",
   "text": "**Absence seizures** are generalized seizures consisting of staring, unresponsiveness, and eye flutter lasting usually for a few seconds. **Typical absences** are associated with 3- Hz spike\u2013and\u2013slow- wave discharges and with childhood absence epilepsy, which has a good prognosis. **Atypical absences** are associated with 1- to 2- Hz spike\u2013 and\u2013slow- wave discharges and with head atonia and myoclonus during the seizures. They occur in **Lennox- Gastaut syndrome** and similar syndromes, which have a poor prognosis. **Juvenile absences** are similar to typical absences but are associated with 4- to 5- Hz spike\u2013and\u2013 slow- wave discharges and often occur in juvenile myoclonic epilepsy. Seizure type and other EEG and clinical manifestations determine the type of **epilepsy syndrome** with which a particular patient is afflicted (see Tables 633.1- 633.6; see also Chapters 633.3 and 633.4)."
  },
  {
   "source": "Berkowitz's Pediatrics, p. 1006",
   "text": "An absence seizure may sometimes be difficult to distinguish from a partial seizure (Table 131.1). The absence spell is a brief (2\u201315 seconds) loss of consciousness without loss of tone. Staring into space and minor movements, such as lip smacking or semi-purposefulappearing movements of the hands are often the only observed behaviors. There is no postictal period. Because absence seizures occur multiple times per day and children are often unaware of them, parents or guardians may dismiss the subtle behavior change as selective attention or daydreaming; however, these seizures may adversely affect learning and carry a risk of injury. Hyperventilation, a useful diagnostic test that can be performed in the office, may provoke absence seizures. The EEG is generally confirmatory and may also distinguish classic petit mal seizures with 3-per-second **982 PART 12: NEUROPSYCHIATRIC DISORDERS**"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 1004",
   "text": "4. How does the physician determine the best course of short- and/or long-term management? Seizures are a common medical problem in children. Diagnosing an episode that does not contain generalized convulsing movements as a seizure is sometimes problematic, however. Seizure is an episodic, stereotypical behavior syndrome of abrupt onset with loss of voluntary control, resulting in loss of responsiveness and rarely provoked by external stimuli. Frequently, the occurrence of this behavior correlates with interictal brain electrical discharges on electroencephalography (EEG), and the behavioral ictus (ie, seizures) should match temporally with a period of electrical hypersynchrony if it occurs during the EEG recording."
  },
  {
   "source": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online, p. 639",
   "text": "![](/tmp/pdf-images/pdf-0638-12.png) **Figure 15-67** Absence seizure. This 8-year-old girl had a history of brief staring spells reported by teachers and family. Typical absence seizures, recorded during a video electroencephalogram with staring and ocular supraversion lasting under 10 seconds, could be activated by hyperventilation. **15**[|] Neurology **615** **Figure 15-68** Absence seizure. This electroencephalographic tracing shows the typical three-per-second (3 Hz) generalized spike-and-wave discharges characteristic of absence seizures. ![](/tmp/pdf-images/pdf-0639-02.png) **----- Start of picture text -----**<br> Fp1\u2013F7<br>F7\u2013T3<br>T3\u2013T5<br>T5\u2013O1<br>Fp2\u2013F8<br>F8\u2013T4<br>T4\u2013T6<br>T6\u2013O2<br>Fp1\u2013F3<br>F3\u2013C3<br>C3\u2013P3<br>P3\u2013O1<br>Fp2\u2013F4<br>F4\u2013C4<br>C4\u2013P4<br>P4\u2013O2<br>Fz\u2013Cz<br>Cz\u2013Pz<br>EKG\u2013PG<br>LE\u2013A1<br>RE\u2013A2<br>PHO\u2013STM<br>**----- End of picture text -----**<br> ![](/tmp/pdf-images/pdf-0639-03.png) LP\ufffd1.0 HF\ufffd38 200 wV 10 S"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Current Evidence Epidemiologic studies indicate that 3% to 6% of children will have at least one seizure in the first 16 years of life; most of these are simple febrile seizures, which generally occur in children 6 months to 6 years old. A seizure is a transient, involuntary alteration of consciousness, behavior, motor activity, sensation, and/or autonomic function caused by an excessive rate and hypersynchrony of discharges from a group of cerebral neurons. The term convulsion is often used to describe a seizure with prominent motor manifestations. Epilepsy, or seizure disorder, is a condition of susceptibility to recurrent seizures."
  },
  {
   "source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 456",
   "text": "[Figure OCR, page 456, figure 1] 12-22 SEIZURE DISORDERS neural tube defects if pregnancy occurs), levetiracetam or lamotrigine are alternative 1* line options. The seizures typically respond well to medications; however, this is usu- ally a lifelong condition and long-term ASMs are required. Absence Seizures Absence seizures (formerly petit mal seizures) are characterized by: \u00a2 Episodes of extremely short lapses in awareness (10-20 seconds) * Absence of aura * Amnesia during the episodes * Short duration (rarely longer than 10-20 seconds) * Abrupt onset and end (frequently in mid-conversation or activity) * Staring and behavioral arrest (with possible flickering of the eyelids or eye rolling or mouth automatisms) * No postictal period Atypical absence seizures additionally can have: \u00ab Brief jerks of the eyelids and limbs \u00a2 Transient change in postural tone (increase or decrease) * Pupillary dilation * Skin-color changes * Tachycardia Atypical absence seizures are not associated with auras,"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "With prolonged seizures, the duration of postictal drowsiness and confusion may also be protracted. However, the child who fails to arouse within 15 to 30 minutes after cessation of seizures should be evaluated carefully to rule out nonconvulsive SE. Children with SE, even if successfully treated in the ED, should be admitted to the hospital for monitoring and observation. Rarely, a child may enter the ED in absence status. In this case, the child may be sitting in a confused or dreamy state. Such attacks may last for hours or even days. The drug of choice in the treatment of absence status is a benzodiazepine at the dosages outlined above."
  }
 ]
}