Last reviewed: 30 Oct 2021
Last updated: 25 Sep 2020



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 investigations

Investigations 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

Treatment algorithm



Judith L. Z. Weisenberg, MD

Assistant Professor of Neurology

Washington University Medical School

St. Louis



JLZW receives 2% salary support from Marinus Pharmaceuticals as site PI for the Marigold Study; 2% salary support from the International Foundation of CDKL5 Research; and 1% salary support as site sub-PHI for the Rett Syndrome Natural History Study. These are all paid to Washington University in St. Louis. JLZW declares that these have no direct relationship to this topic.


Dr Judith L. Z. Weisenberg would like to gratefully acknowledge Dr Michael Wong, a previous contributor to this topic. MW declares that he has no competing interests.

Peer reviewers

Anita Devlin, MBBS, MD

Consultant Paediatric Neurologist

Royal Victoria Infirmary

NHS Foundation Trust




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



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




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




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.

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