Absence Seizure
Absence seizures involve brief, sudden lapses of consciousness. They’re more common in children than in adults.
A person having an absence seizure may stare blankly into space for a few seconds. Then the person typically returns quickly to being alert. This type of seizure usually doesn’t lead to physical injury. But injury can happen if someone is driving a car or riding a bike when the seizure happens.
Absence seizures usually can be managed with antiseizure medicines. Some children who have them also develop other seizures, such as generalized tonic-clonic seizures or myoclonic seizures. Many children outgrow absence seizures in their teens.
A simple absence seizure causes a vacant stare, which may be mistaken for a brief lapse in attention. The seizure lasts about 10 seconds, though it may last as long as 30 seconds. There’s no confusion, headache or drowsiness after the seizure.
Symptoms of absence seizures include:
- A sudden stop in activity without falling.
- Lip smacking.
- Eyelid flutters.
- Chewing motions.
- Finger rubbing.
- Small movements of both hands.
Afterward, there’s usually no memory of the incident. But if the seizure is longer, the person may be aware of missed time. Some people have many episodes daily. When it happens, it can interfere with school or daily activities.
A child may have absence seizures for some time before an adult notices them. This is because the seizures are so brief. A decline in a child’s learning ability may be the first sign of the seizure disorder. Teachers may say the child has trouble paying attention or that a child is often daydreaming.
When to see a doctor
Contact your child’s pediatrician:
- If you’re concerned that your child may be having seizures.
- If your child has epilepsy but develops symptoms of a new type of seizure.
- If the seizures continue to occur despite taking antiseizure medicine.
Contact 911 or emergency services in your area:
- If you observe prolonged automatic behaviors lasting minutes to hours. This may include activities such as eating or moving without awareness. It also might include prolonged confusion. These are possible symptoms of a condition called status epilepticus.
- After any seizure lasting more than five minutes.
Absence seizures usually have a genetic cause.
In general, seizures occur as a result of a burst of electrical impulses from nerve cells in the brain, called neurons. Neurons typically send electrical and chemical signals across the synapses that connect them.
In people who have seizures, the brain’s usual electrical activity is altered. During an absence seizure, these electrical signals repeat themselves over and over in a three-second pattern.
People who have seizures also may have altered levels of the chemical messengers that help the nerve cells communicate with one another. These chemical messengers are called neurotransmitters.
Certain factors are common to children who have absence seizures, including:
- Age. Absence seizures are more common in children between the ages of 4 and 14.
- Sex. Absence seizures are more common in females.
- Family members who have seizures. Nearly a quarter of children with absence seizures have a close relative who has seizures.
While most children outgrow absence seizures, some:
- Must take antiseizure medicines throughout life.
- Eventually have full convulsions, such as generalized tonic-clonic seizures.
Other complications can include:
- Trouble with learning.
- Trouble with behavior.
- Social isolation.
- Injury during the seizure.
Your child’s healthcare professional asks for a detailed description of the seizures and does a physical exam. Tests may include:
Electroencephalography (EEG). This painless procedure measures waves of electrical activity in the brain. Brain waves are transmitted to the EEG machine via small metal plates called electrodes that are attached to the scalp with paste or an elastic cap.
Rapid breathing, known as hyperventilation, during an EEG study can trigger an absence seizure. During a seizure, the pattern on the EEG differs from the typical pattern.
- Brain scans. Brain-imaging methods such as MRI can help rule out other conditions, such as a stroke or a brain tumor. Brain scans produce detailed images of the brain. Because your child needs to hold still for long periods, talk with your healthcare professional about the possible use of sedation.
Your child’s healthcare professional may start at the lowest dose of antiseizure medicine possible. Then the dose may be increased as needed to manage the seizures. Children may be able to taper off antiseizure medicines under the supervision of a healthcare professional after they’ve been seizure-free for two years.
Medicines prescribed for absence seizure include:
- Ethosuximide (Zarontin). This often is the first medicine prescribed for absence seizures. Most people see improvement in their seizures with this medicine. Possible side effects include nausea, vomiting, sleepiness, sleep disturbances and hyperactivity.
Valproic acid. Valproic acid treats children who have both absence and tonic-clonic seizures, also known as grand mal seizures. Side effects of valproic acid include nausea, attention problems, increased appetite and weight gain. Rarely, the medicine can cause inflammation of the pancreas and liver failure.
Females who continue to need medicine into adulthood need to talk about the potential risks of valproic acid with their healthcare professionals. Valproic acid has been linked to a higher risk of birth defects in babies. Healthcare professionals typically advise not using it during pregnancy or while trying to conceive.
- Lamotrigine (Lamictal). Some studies show this medicine to be less effective than ethosuximide or valproic acid, but it has fewer side effects. Side effects may include rash and nausea.
References
- Absence seizures. The Epilepsy Foundation. http://www.epilepsy.com/learn/types-seizures/absence-seizures. Accessed March 12, 2023.
- Korff CM. Childhood absence epilepsy. https://www.uptodate.com/contents/search. Accessed March 12, 2023.
- Loscalzo J, et al., eds. Seizures and epilepsy. In: Harrison’s Principles of Internal Medicine. 21st ed. McGraw Hill; 2022. https://accessmedicine.mhmedical.com. Accessed March 7, 2023.
- Epilepsy and seizures. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/epilepsy-and-seizures#. Accessed March 12, 2023.
- Rinaldi VE, et al. Therapeutic options for childhood absence epilepsy. Pediatric Reports. 2021; doi:10.3390/pediatric13040078.
- Brigo F, et al. Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents. Cochrane Database of Systematic Reviews. 2021; doi:10.1002/14651858.CD003032.pub5.
- Schachter SC. Antiseizure drugs: Mechanism of action, pharmacology, and adverse effects. https://www.uptodate.com/contents/search. Accessed March 7, 2023.
- Medical review (expert opinion). Mayo Clinic. March 14, 2023.
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