An Overview of Absence Seizures

These non-convulsive seizures look like staring spells

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An absence seizure, often referred to as petit mal seizure, is a non-convulsive seizure that is often not recognized as a seizure at all. Absence seizures usually occur in children who have epilepsy, but adults can have them as well. While absence seizures are not as disruptive or obvious as convulsive seizures, they cause impairment of consciousness and interfere with learning, driving, and other aspects of life.

Absence seizures are typically a childhood condition. For children who do not have other types of seizures, absence seizures tend to stop on their own after adolescence. Often, children who have epilepsy characterized by multiple seizure types also experience a significant decrease in the absence seizure type after adolescence.

Symptoms

Absence seizures can go unnoticed. They can occur several times a day and rarely cause disruption, noise, or clearly obvious manifestations. Sometimes, a person may experience them for months before others begin to take notice.

A typical absence seizure manifests as a staring spell that can last between 10 and 30 seconds.

The person experiencing the seizure is usually not aware that it's happening. Consciousness is impaired, which means they're not aware of their surroundings or movements. Unlike other seizures, absence seizures do not cause jerking movements or physical convulsions, however.

After the seizure, they will quickly resume awareness and continue what they were doing before it came on.

What Observers Witness

If you see someone having an absence seizure, it may seem like they're not paying attention to you. A child having one in a classroom, for example, can appear to be bored or daydreaming.

Rapid blinking of the eyes or automatisms (purposeless movements), such as finger tapping or lip-smacking, may occur as well. Absence seizures are more noticeable if they occur during a physical task or while interacting with someone.

Causes 

Absence seizures are caused by abnormal electrical activity throughout the brain. Doctors can't always figure out why a person develops this type of seizure, but in most cases, there's no genetic component that has been identified so far.

Most people who experience absence seizures don't experience other types of seizures. However, some people who have absence seizures may have a family history of epilepsy.

Someone with absence seizures may have other medical conditions characterized by severe developmental delay. They may also have a medication-resistant form of epilepsy—such as Rett syndrome, Lennox-Gastaut syndrome, or Dravet syndrome—that involves convulsive seizures and absence seizures.

Diagnosis

Absence seizures are usually first noticed in children between the ages of 4 and 8, but they can also begin during early adolescence. Parents, teachers, coaches and other adults who are familiar with childhood behavior and habits may recognize the episodes as seizures, rather than just simple "boredom." A medical evaluation can help confirm the diagnosis so that treatment can be initiated.

A doctor will begin by taking a careful medical history, and will ask about specific signs and symptoms. You can use our Doctor Discussion Guide below to help you have that conversation.

Epilepsy Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Child

Often, brain magnetic resonance imaging (MRI) is needed to identify whether there is a lesion in the brain that could be causing the episodes. A temporal lobe lesion, for example, can cause temporal lobe seizures, which may also manifest with repetitive movements and be mistaken for absence seizures.

An electroencephalogram (EEG) will show a symmetrical 3 Hz spike and wave pattern. This is described as generalized seizure activity because it involves both sides of the brain, in contrast to focal seizure activity, which involves only one region.

Often, the abnormalities on EEG can be elicited by hyperventilation, so your child may be asked to breathe rapidly during the EEG so that the pattern can emerge.

Other Possible Conditions

Other possible conditions that may mimic absence seizures include:

Treatment

Absence seizures are treated with specific anti-seizure medications. If convulsive seizures occur along with absence seizures, more than one of these drugs may be necessary.

The medications used to treat absence seizure are:

  • Zarontin (ethosuximide)
  • Depakene (valproic acid)
  • Lamictal (lamotrigine)

Lifestyle Management

In addition to treatment, triggers that worsen the seizures or that are known to make them more frequent should be avoided.

Known seizure triggers include:

  • Sleep deprivation
  • Alcohol
  • Recreational drugs
  • Smoking
  • Hyperventilation
  • Prolonged breath holding (like swimming under water)
  • Fevers: Use medication to lower fevers during an infection.
  • Skipping meals
  • Illness
  • Stress/anxiety
  • Changes in anti-convulsant doses or other medication changes: Speak with your doctor before making any adjustments to a drug regimen.

Coping

People with absence seizures are faced with having to manage various daily life and safety concerns. As a family member/caretaker, you can help them address these issues preemptively.

Safety

In general, absence seizures do not cause falls or injuries. However, if they happen while driving, swimming, or riding a bike, the loss of consciousness can cause an accident. Make sure that your loved one only participates in these activities if the seizures are well controlled.

School and Work

Encourage adequate sleep, food, and drink. Skipping meals and skimping on sleep can lead to seizures, which can lead to missed classes and falling behind, for example. Be sure to discuss your child's condition with teachers and see if your child can borrow notes or slides in order to stay on top of lessons.

Social

Staring spells can cause individuals to miss out on group conversations or to "blank out" during interactions with others.

For a child with absence seizures, it may help to give them examples of how to explain their seizures to friends. Whether your child discusses this with peers is a very individual decision based on the circumstances and the people involved. Try not to push them to talk about it and offer support and guidance if they do want to be open about it.

For someone older, it may help to develop a simple, straightforward way to let people know about the blank spells and to let them know when one has occurred.

It may not always be comfortable or possible to explain the condition in social situations. When a trusted person is present, try to work out ways they can help you catch up on the information you miss.

A Word From Verywell

Absence seizures are not usually harmful in an obvious way, but they can cause misunderstandings that can make the condition increasingly difficult. Family members, teachers, coaches, and friends can become angry when a child who has absence seizures seems to be ignoring them or not responding appropriately. It's a challenge, and your child will benefit from your creating a loving and supportive family and social network. This may take time but is well worth the effort.

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