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

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 mental retardation
  • 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
More investigations to consider

Treatment algorithm

Contributors

Assistant Professor of Neurology

Washington University Medical School

St. Louis

MO

Disclosures

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 reviewersVIEW ALL

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.

Division of Pediatric Neurology

Columbia University College of Physicians and Surgeons

New York

NY

Disclosures

CA declares that he has no competing interests.

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.

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.

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