Seizure

Absence Seizure

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Absence Seizure, Petit Mal Seizure, Minor Seizure

  • Precautions
  1. Adults with what appears to be Absence Seizures (Petit Mal Seizure) are likely having Partial Seizures
  • Epidemiology
  1. Almost exclusively occurs between age 5 and 18
  2. Rare before age 2 years or after adolescence
  • Causes
  1. Inherited idiopathic Seizure Disorder
  2. Secondary Seizure Disorder
    1. Vascular Malformation
    2. Infectious disease
    3. Neoplasm
    4. Toxic brain disease
  • Symptoms and Signs
  1. Vacant, dazed facial expression
    1. Staring
    2. Impaired Consciousness
    3. Pallor
  2. Timing of episodes
    1. Occur Multiple times per day
    2. Brief interruption of current activity
    3. Short spells last 10 seconds
  3. Rhythmic activity
    1. Eye blinking
    2. Head movement
  4. Autonomic symptoms
    1. Incontinence of urine or stool
    2. Loss of postural control
  5. Unusual postictal activity
    1. Picking at clothes
    2. Pursing lips
  • Differential Diagnosis
  1. Complex Partial Seizure
  2. Daydreaming
  3. Attention Deficit Hyperactivity Disorder
  1. Bilateral, synchronous and symmetric pattern
  2. Three hertz wave-spike Dysrhythmia over Frontal Lobe
  • Course
  1. Most patients will cease Absence Seizures by age 20
    1. Absence Seizures began in childhood
    2. Seizures not due to secondary cause
  2. Untreated Absence Seizures progress in 33% of patients
    1. Generalized Tonic Clonic Seizure
  • Management
  • Prophylaxis
  1. Ethosuximide
  2. Valproic Acid
  3. Clonazepam
  • Management
  • Prophylaxis for Children (age <16 years)
  1. Level A evidence
    1. Ethosuximide (Zarontin)
    2. Valproic Acid (Depakene)
  2. Level C evidence
    1. Lamotrigine (Lamictal)
  • Management
  • Prophylaxis for Younger Adults (age >16 years)
  1. Level C evidence
    1. Carbamazepine (Tegretol)
    2. Lamotrigine (Lamictal)
    3. Oxcarbazepine (Trileptal)
    4. Phenobarbital
    5. Phenytoin (Dilantin)
    6. Topiramate (Topamax)
    7. Valproic Acid (Depakene)
  2. Level D evidence
    1. Gabapentin (Neurontin)
    2. Levetiracetam (Keppra)
    3. Vigabatrin (Sabril)
  • References
  1. Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]