II. Precautions

  1. Adults with what appears to be Absence Seizures (Petit Mal Seizure) are likely having Partial Seizures

III. Epidemiology

  1. Almost exclusively occurs between age 5 and 18
  2. Rare before age 2 years or after adolescence

IV. Causes

  1. Inherited idiopathic Seizure Disorder
  2. Secondary Seizure Disorder
    1. Vascular Malformation
    2. Infectious disease
    3. Neoplasm
    4. Toxic brain disease

V. Symptoms and Signs

  1. Vacant, dazed facial expression
    1. Staring
    2. Impaired Consciousness
    3. Pallor
  2. Timing of episodes
    1. Occur Multiple times per day
    2. Brief interruption of current activity
    3. Short spells last 10 seconds
  3. Rhythmic activity
    1. Eye blinking
    2. Head movement
  4. Autonomic symptoms
    1. Incontinence of urine or stool
    2. Loss of postural control
  5. Unusual postictal activity
    1. Picking at clothes
    2. Pursing lips

VI. Differential Diagnosis

VII. Diagnosis: Electroencephalogram

  1. Bilateral, synchronous and symmetric pattern
  2. Three hertz wave-spike Dysrhythmia over Frontal Lobe

VIII. Course

  1. Most patients will cease Absence Seizures by age 20
    1. Absence Seizures began in childhood
    2. Seizures not due to secondary cause
  2. Untreated Absence Seizures progress in 33% of patients
    1. Generalized Tonic Clonic Seizure

IX. Management: Prophylaxis

X. Management: Prophylaxis for Children (age <16 years)

  1. Level A evidence
    1. Ethosuximide (Zarontin)
    2. Valproic Acid (Depakene)
  2. Level C evidence
    1. Lamotrigine (Lamictal)

XI. Management: Prophylaxis for Younger Adults (age >16 years)

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