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Absence seizures

Last reviewed: 14 Sep 2025
Last updated: 07 May 2025

Summary

Definition

History and exam

Key diagnostic factors

  • family history of childhood seizures
  • staring episode, lasting 5 to 10 seconds; several times per day with no aura/postictal state
  • childhood onset
  • normal physical exam
  • hyperventilation-induced seizure
Full details

Other diagnostic factors

  • simple automatisms
  • recent decline in school performance
  • complex automatisms
  • early onset (before age 4 years)
Full details

Risk factors

  • family/genetic history of childhood absence epilepsy or juvenile myoclonic epilepsy
  • acquired brain injury: for example, hypoxia-ischemia, trauma, infection
  • other congenital inborn errors of metabolism, structural defects, chromosomal abnormalities
  • developmental delay or intellectual disability
  • female sex
Full details

Diagnostic tests

1st tests to order

  • EEG
Full details

Tests to consider

  • MRI brain
  • testing for metabolic disorders (e.g., serum amino acids, urine organic acids, lactate pyruvate or specific enzymatic tests)
  • cerebrospinal fluid and serum glucose
Full details

Emerging tests

  • gene testing

Treatment algorithm

ACUTE

typical absence seizures without a history of generalized tonic-clonic seizures (childhood absence epilepsy)

typical absence seizures with a history of generalized tonic-clonic seizures (CAE, JAE, JME)

atypical absence seizures

CONTÍNUA

refractory to treatment

Colaboradores

Autores

Judith L. Z. Weisenberg, MD

Assistant Professor of Neurology

Washington University Medical School

St. Louis

MO

Disclosures

JLZW states that she has no competing interests.

Acknowledgements

Dr Judith L. Z. Weisenberg would like to gratefully acknowledge Dr Michael Wong, a previous contributor to this topic.

Disclosures

MW declares that he has no competing interests.

Peer reviewers

Anita Devlin, MBBS, MD

Consultant Paediatric Neurologist

Royal Victoria Infirmary

NHS Foundation Trust

Newcastle-upon-Tyne

UK

Disclosures

AD and two epilepsy nurses from her department have been reimbursed by UCB Pharma, the manufacturer of levetiracetum, for attending several conferences. One of the epilepsy nurses received a one-off sponsorship payment from UCB Pharma to cover the initial set-up costs of the adolescent epilepsy support group. One epilepsy nurse has been reimbursed by Cyberonics, the manufacturer of vagal nerve stimulators, for attending one or more conferences.

Cigdem Akman, MD

Division of Pediatric Neurology

Columbia University College of Physicians and Surgeons

New York

NY

Disclosures

CA declares that he has no competing interests.

Angus A. Wilfong, MD

Associate Professor

Pediatrics and Neurology

Baylor College of Medicine

Medical Director

Comprehensive Epilepsy Program

Texas Children's Hospital

Houston

TX

Declarações

AAW declares that he has no competing interests.

Helen Cross, MB, ChB, PhD, FRCP, FRCPCH

Head of Neurosciences Unit

The Prince of Wales’s Chair of Childhood Epilepsy

National Centre for Young People with Epilepsy

London

UK

Declarações

HC has received research funds from HAS, Epilepsy Research UK, SHS, and the Milk Development Council. She has received funding for an epilepsy training fellowship from UCB and Eisai. She has also received travel funding from Eisai, UCB, and GlaxoSmithKline.

Créditos aos pareceristas

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Referências

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Principais artigos

Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):522-30.Texto completo  Resumo

Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010 Apr;51(4):676-85. Resumo

Rosenow F, Wyllie E, Kotagal P, et al. Staring spells in children: descriptive features distinguishing epileptic and nonepileptic events. J Pediatr. 1998 Nov;133(5):660-3. Resumo

Glauser TA, Cnaan A, Shinnar S, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med. 2010 Mar 4;362(9):790-9.Texto completo  Resumo

Glauser TA, Cnaan A, Shinnar S, et al. Ethosuximide, valproic acid and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months. Epilepsia. 2013 Jan;54(1):141-55.Texto completo  Resumo

Bergey GK. Evidence-based treatment of idiopathic generalized epilepsies with new antiepileptic drugs. Epilepsia. 2005;46 Suppl 9:161-8. Resumo

Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: efficacy and tolerability of the new antiepileptic drugs I: treatment of new-onset epilepsy: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2018 Jul 10;91(2):74-81.Texto completo  Resumo

Nordli DR Jr. Idiopathic generalized epilepsies recognized by the International League Against Epilepsy. Epilepsia. 2005 Nov 18;46(suppl 9):48-56.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Diagnósticos diferenciais

    • Daydreaming
    • Attention deficit hyperactivity disorder (ADHD)
    • Complex partial epilepsy of frontal or temporal lobe origin
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Teratogenesis, perinatal, and neurodevelopmental outcomes after in utero exposure to antiseizure medication
    • Epilepsies in children, young people and adults
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Absence seizures in children

    Mais Folhetos informativos para os pacientes
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