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
Other diagnostic factors
- simple automatisms
- recent decline in school performance
- complex automatisms
- early onset (before age 4 years)
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
Diagnostic tests
1st tests to order
- EEG
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
Emerging tests
- gene testing
Treatment algorithm
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
refractory to treatment
Contributors
Authors
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
Disclosures
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
Disclosures
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.
Differentials
- Daydreaming
- Attention deficit hyperactivity disorder (ADHD)
- Complex partial epilepsy of frontal or temporal lobe origin
More DifferentialsGuidelines
- Epilepsies in children, young people and adults
- Antiseizure medication withdrawal in seizure-free patients: practice advisory update summary
More GuidelinesPatient information
Absence seizures in children
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