Neurology Book

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Absence Seizure

Aka: Absence Seizure, Petit Mal Seizure, Minor Seizure
  1. Precautions
    1. Adults with what appears to be Absence Seizures (Petit Mal Seizure) are likely having Partial Seizures
  2. Epidemiology
    1. Almost exclusively occurs between age 5 and 18
    2. Rare before age 2 years or after adolescence
  3. Causes
    1. Inherited idiopathic Seizure Disorder
    2. Secondary Seizure Disorder
      1. Vascular Malformation
      2. Infectious disease
      3. Neoplasm
      4. Toxic brain disease
  4. 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
  5. Differential Diagnosis
    1. Complex Partial Seizure
    2. Daydreaming
    3. Attention Deficit Hyperactivity Disorder
  6. Diagnosis: Electroencephalogram
    1. Bilateral, synchronous and symmetric pattern
    2. Three hertz wave-spike Dysrhythmia over Frontal Lobe
  7. 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
  8. Management: Prophylaxis
    1. Ethosuximide
    2. Valproic Acid
    3. Clonazepam
  9. 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)
  10. Management: Prophylaxis for Younger Adults (age >16 years)
    1. Level C evidence
      1. Carbamazepine (Tegretol)
      2. Lamotrigine (Lamictal)
      3. Oxcarbazepine (Trileptal)
      4. Phenobarbital
      5. Phenytoin (Dilantin)
      6. Topiramate (Topamax)
      7. Valproic Acid (Depakene)
    2. Level D evidence
      1. Gabapentin (Neurontin)
      2. Levetiracetam (Keppra)
      3. Vigabatrin (Sabril)
  11. References
    1. Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]

Absence Epilepsy (C0014553)

Definition (NCI) Generalized seizure that manifests in a form of a brief episode of impairment of consciousness with or without accompanying motor phenomena such as clonic-tonic components, automatisms, or autonomic components.
Definition (NCI_FDA) The seizure seen in absence epilepsy, consisting of a sudden momentary break in consciousness of thought or activity, often accompanied by automatisms or clonic movements, especially of the eyelids.(CDRH)
Definition (NCI) Epilepsy characterized by very brief episodes of sudden cessation of activity, usually associated with eye blinking. There is no loss of the muscle tone.
Definition (MSH) A childhood seizure disorder characterized by rhythmic electrical brain discharges of generalized onset. Clinical features include a sudden cessation of ongoing activity usually without loss of postural tone. Rhythmic blinking of the eyelids or lip smacking frequently accompanies the SEIZURES. The usual duration is 5-10 seconds, and multiple episodes may occur daily. Juvenile absence epilepsy is characterized by the juvenile onset of absence seizures and an increased incidence of myoclonus and tonic-clonic seizures. (Menkes, Textbook of Child Neurology, 5th ed, p736)
Concepts Disease or Syndrome (T047)
MSH D004832
ICD10 G40.7, G40.A
SnomedCT 79631006, 163596002, 192983009, 16757004, 192980007, 140805008, 155037000, 50866000, 230413002
English Absence Seizures, Epilepsy, Absence, Epilepsy, Petit Mal, Petit Mal Epilepsies, Pyknolepsies, Pyknolepsy, Seizure, Absence, Petit Mal Epilepsy, PETIT MAL, Absence seizures, Childhood (juv) absence epilep, EPILEPSY IDIOPATHIC PETIT MAL, Petit mal, unspecified, without grand mal seizures, Absence Seizure, Petit Mal Seizure, Petit Mal, Petit-Mal Seizure, Seizures, absence, ABSENCE SEIZURE DIS, SEIZURE DIS ABSENCE, childhood petit mal seizure (diagnosis), childhood petit mal seizure, epilepsy generalized nonconvulsive pykno-epilepsy (diagnosis), epilepsy generalized nonconvulsive pykno-epilepsy, juvenile petit mal seizure (diagnosis), juvenile petit mal seizure, petit mal seizure, juvenile, generalized nonconvulsive petit mal seizure, petit mal seizure, petit mal seizure (diagnosis), petit mal seizure, childhood, pykno-epilepsy, Convulsion petit mal, Petit mal convulsion, Epilepsy petit mal, Petit mal epilepsy, Absence Seizure Disorder, Absence Seizure Disorders, Seizure Disorder, Absence, Seizure Disorders, Absence, Convulsion, Petit Mal, Petit Mal Convulsion, Epilepsy, Minor, Minor Epilepsies, Minor Epilepsy, Pykno Epilepsy, Pykno-Epilepsies, Pykno-Epilepsy, Epilepsy, Absence [Disease/Finding], absence epilepsy, epilepsy absence, mal petit seizure, mal petit seizures, Seizure;absence, absence seizure, absence seizure disorder, absences epilepsy, childhood absence epilepsy, petit mal epilepsy, seizures absence, typical absence, mals petit, mal petit, petit mal seizures, seizure petit mal, absence seizures, minor epilepsy, petit mal, Epilepsy Juvenile Absence, Epilepsy Juvenile Absences, Juvenile Absences, Epilepsy, Juvenile Absence, Epilepsy, Absence seizure (finding), Petit mal (disorder), SEIZURES, ABSENCE, SEIZURES, PETIT-MAL, PETIT-MAL SEIZURES, Absence seizure, Petit mal, Pykno-epilepsy, Childhood absence epilepsy, Childhood - juvenile - absence epilepsy, Petit-mal epilepsy, Petit-mal seizure, Juvenile absence epilepsy, Childhood absence epilepsy (disorder), Absence seizure (disorder), Juvenile absence epilepsy (disorder), pyknolepsy, epilepsy; absence, epilepsy; minor, epilepsy; petit mal, absence; epileptic, absences; epileptic, petit mal; epilepsy, Absence Epilepsies, Childhood, Absence Epilepsy, Childhood, Childhood Absence Epilepsies, Childhood Absence Epilepsy, Epilepsies, Childhood Absence, Epilepsy, Childhood Absence, Absence Epilepsies, Juvenile, Absence Epilepsy, Juvenile, Epilepsies, Juvenile Absence, Epilepsy, Juvenile Absence, Juvenile Absence Epilepsies, Juvenile Absence Epilepsy, Absence Epilepsy, Absences, typical, Minor epilepsy, absence of seizure
French Absences épileptiques, Epilepsie petit mal, Convulsion de petit mal, Convulsion petit mal, PETIT MAL, Petit mal épileptique, Petit mal, Absence épileptique, Crises d'absence
German Absence-Anfaelle, Konvulsion Petit-mal, Petit-mal-Konvulsion, Epilepsie Petit-mal, Petit-mal, Absenceanfall, PETIT MAL, Petit-mal-Anfaelle, nicht naeher bezeichnet, ohne Grand-mal-Anfaelle, Petit mal Epilepsie, Epilepsie, Absence-, Epilepsie, Petit mal-, Petit-mal-Epilepsie, Pyknolepsie, Absencenepilepsie, Epilepsie, Minor-, Absencenanfälle
Italian Assenze epilettiche, Epilessia da piccolo male, Piccolo male epilettico, Assenza epilettica, Convulsione da piccolo male, Piccolo male, Picno-epilessia, Epilessia minor, Epilessia tipo piccolo male giovanile, Epilessia con assenza dell'infanzia, Disturbo da attacco tipo assenza, Epilessia tipo piccolo male dell'infanzia, Attacchi tipo assenza, Convulsioni da piccolo male, Picnoepilessia,, Epilessia tipo piccolo male
Dutch petit mal, petit mal convulsie, absence insult, epilepsie petit mal, convulsie petit mal, absence; epilepsie, absences; epileptisch, epilepsie; absence, epilepsie; minor, epilepsie; petit mal, petit mal; epilepsie, Petit mal zonder grandmalaanvallen, niet gespecificeerd, absences, petit mal epilepsie, Absence, Petit mal, Pycnolepsie
Portuguese Pequeno mal, Convulsão de pequeno mal, Crise de ausência, Petit mal epiléptico, PEQUENO MAL, Epilepsia Minor, Epilepsia de Ausência, Epilepsia do Tipo Ausência, Crises de ausência, Pequeno mal epiléptico, Crises de Ausência, Epilepsia do Pequeno Mal, Epilepsia Menor, Epilepsia Tipo Ausência, Picnoepilepsia
Spanish Convulsión de pequeño mal, Petit mal, PEQUENO MAL, Crisis de ausencia, ausencia, petit mal, petit mal (concepto no activo), ausencias, convulsiones de ausencia, crisis de ausencia (trastorno), crisis de ausencia, epilepsia de ausencia en la niñez (trastorno), epilepsia de ausencia en la niñez, epilepsia juvenil con ausencias (trastorno), epilepsia juvenil con ausencias, pequeño mal, Ausencias, Epilepsia de pequeño mal, Crisis de Ausencia, Epilepsia del Pequeño Mal, Epilepsia Menor, Epilepsia Tipo Ausencia, Picnolepsia
Japanese 小発作痙攣, ｼｮｳﾎｯｻ, ｼｮｳﾎｯｻﾃﾝｶﾝ, ｹｯｼﾝﾎｯｻ, ｼｮｳﾎｯｻｹｲﾚﾝ, 無動小発作, 癲癇-小発作, 小発作てんかん, てんかん-小発作, 小発作癲癇, 欠神発作, ピクノレプシー, 小発作, 欠神てんかん, てんかん-欠神
Swedish Absensepilepsi
Czech epilepsie petit mal, Epilepsie typu petit mal, Epilepsie petit mal, Absence záchvatů, Konvulzivní petit mal záchvat, Petit mal, Malý záchvat křečový, Záchvat absence
Finnish Poissaolokohtaukset
Russian ABSANS, AKINETICHESKII MALYI PRIPADOK, EPILEPSIIA PETIT MAL, EPILEPTICHESKII MALYI PRIPADOK, EPILEPSIIA, ABSANS, ABSANS EPILEPTICHESKII, PETIT MAL EPILEPSIIA, PETIT MAL ЭПИЛЕПСИЯ, АБСАНС, АБСАНС ЭПИЛЕПТИЧЕСКИЙ, АКИНЕТИЧЕСКИЙ МАЛЫЙ ПРИПАДОК, ЭПИЛЕПСИЯ PETIT MAL, ЭПИЛЕПСИЯ, АБСАНС, ЭПИЛЕПТИЧЕСКИЙ МАЛЫЙ ПРИПАДОК
Korean 대발작이 없는 상세불명의 소발작
Polish Napad padaczkowy abscence, Pykno-epilepsja, Petit mal, Napad padaczkowy mały, Napad nieświadomości
Hungarian Petit-mal-convulsio, Petit mal convulsio, Petit mal epilepszia, Petit mal epilepsia, Petit mal, Absence epilepsziás roham, Absence epilepsziás rohamok
Norwegian Absensepilepsi, Barneabsensepilepsi, Absensepilepsi hos barn, Pyknolepsi, Juvenil absensepilepsi
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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