absence (petit-mal) seizure
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Etiology
- may be associated with other generalized seizure types
- generalized tonic-clonic seizures
- commonly seen in adult-onset epilepsies (MKSAP20)[3]
- may occur as the only seizure type in school-aged children
Epidemiology
- age 3-15 years
- uncommon in adults (not in adults)[3]
- case in 18 year old man with history of a single generalized tonic-clonic seizure 6 months prior (MKSAP20)[3]
Pathology
Clinical manifestations
- sudden loss of consciousness
- motionless stare
- automatisms
- rhythmic eye blinking
- lip smacking
- chewing
- swallowing
- hand movements
- brief, 30 seconds; < 5 seconds[3]; many per day
- typically last < 20 seconds
- seizure ends suddenly with the patient fully alert
- no postictal state
* memory problems, confusion, falls, dizziness, numbness (presumptively absence seizure)[5]
Laboratory
- electroencephalogram (EEG) shows 3 Hz spike wave complexes
Differential diagnosis
- focal seizure
- both absence seizure & focal seizure may begin as staring spells
- focal seizures with impaired awareness have longer duration 15-60 vs < 20 seconds, lower frequency (not many/day) & presence of aura & post-ictal state[2]
- non-convulsive status epilepticus in older adults
Management
- ethosuximide (Zarontin) agent of choice[4]
- alternative agents
- pregnancy:
- if not taking anticonvulsant, & no seizures in 18 months, observe[5]
More general terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1034-35
- ↑ 2.0 2.1 Alan Gelb, UCSF, Department of Emergency Services, San Francisco General Hospital, 1998
- ↑ 3.0 3.1 3.2 3.3 3.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 16. 17. 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 4.0 4.1 Glauser TA et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med 2010 Mar 4; 362:790. PMID: https://pubmed.ncbi.nlm.nih.gov/20200383
Vining EPG. Ethosuximide in childhood absence epilepsy - Older and better. N Engl J Med 2010 Mar 4; 362:843. PMID: https://pubmed.ncbi.nlm.nih.gov/20200390 - ↑ 5.0 5.1 5.2 NEJM Knowledge+ Neurology
- ↑ NEJM Knowledge+ Psychiatry
- ↑ Epilepsy and Seizures in Older Adults https://www.cdc.gov/epilepsy/communications/features/olderadults.htm