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absence (petit-mal) seizure

Epidemiology: 1) age 3-15 years 2) uncommon in adults (not in adults) [3] Pathology: - generalized seizure Clinical manifestations: 1) sudden loss of consciousness 2) motionless stare 3) automatisms a) rhythmic eye blinking b) lip smacking c) chewing d) swallowing e) hand movements 4) brief, 30 seconds; < 5 seconds [3]; many per day - typically last < 20 seconds 5) seizure ends suddenly with the patient fully alert 6) 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: 1) ethosuximide (Zarontin) agent of choice [4] 2) alternative agents a) valproate (Depakote) b) clonazepam (Klonopin) c) lamotrigine (Lamictal) d) topiramate (Topamax) 3) pregnancy: - if not taking anticonvulsant, & no seizures in 18 months, observe [5]

General

primary generalized seizure

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1034-35
  2. Alan Gelb, UCSF, Department of Emergency Services, San Francisco General Hospital, 1998
  3. 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
  4. Glauser TA et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med 2010 Mar 4; 362:790. PMID: 20200383 - Vining EPG. Ethosuximide in childhood absence epilepsy - Older and better. N Engl J Med 2010 Mar 4; 362:843. PMID: 20200390
  5. NEJM Knowledge+ Neurology
  6. NEJM Knowledge+ Psychiatry
  7. Epilepsy and Seizures in Older Adults https://www.cdc.gov/epilepsy/communications/features/olderadults.htm