Absence Seizures: Understanding the Condition and Its Management

Absence seizures, previously referred to as petit mal seizures, are a type of epilepsy most commonly diagnosed in children. This condition typically begins between the ages of 4 and 8, with a peak onset around age 5. Girls are more commonly affected than boys, making up approximately 60 to 70 percent of cases. Children usually develop normally before symptoms begin, and the seizures are characterized by sudden, brief lapses in consciousness or awareness. These episodes may be accompanied by automatic movements or mild muscle jerks, and can occur multiple times a day—sometimes numbering in the hundreds.

Recognizing the Symptoms

Unlike more dramatic forms of epilepsy, absence seizures do not involve falling down or convulsions. Additionally, individuals typically do not feel fatigued after an episode. Each seizure lasts less than 10 seconds, which often leads to them being overlooked or misunderstood. Parents, teachers, or caregivers may mistake these episodes for daydreaming or inattentiveness, especially in school settings.

Diagnosis and EEG Findings

Before treatment begins, absence seizures can often be triggered through a hyperventilation test. During a standard electroencephalogram (EEG), combined with hyperventilation, a distinct pattern of bilateral, synchronous 3Hz spike-and-wave discharges is typically observed. This unique brainwave pattern is a key diagnostic indicator of absence epilepsy and helps differentiate it from other seizure types.

Understanding the Causes

The exact cause of absence epilepsy remains unclear, but there is a strong genetic component. Research suggests it may be inherited as an autosomal dominant trait or result from multiple genetic factors. Family history often reveals other relatives with seizure disorders, further supporting the hereditary nature of this condition.

Treatment Options

Valproate and ethosuximide are considered the most effective medications for treating childhood absence epilepsy. However, ethosuximide is not currently available in some regions. For adolescent girls, lamotrigine is often the preferred treatment option, successfully controlling seizures in about 80 percent of cases. If seizures are well-managed for two to three years, a physician may recommend gradually tapering off medication under careful supervision.