Absence seizure

Clinic

• It is one of several kinds of generalized seizures, sometimes referred to as petit mal seizures
• Characterized by a brief loss and return of consciousness, generally not followed by a period of lethargy (i.e. without a notable postictal state)
• Most common in children
• They affect both sides of brain.
• Childhood absence seizures account for 10-17% of all absence seizures.

Signs / Symptoms

• Abrupt and sudden-onset impairment of consciousness
• Interruption of ongoing activities
• A blank stare
• Possibly a brief upward rotation of eyes

• If the patient is speaking, speech is slowed or interrupted; if walking, they stand transfixed
• If eating, the food will stop on its way to the mouth.
• Usually, the patient will be unresponsive when addressed.
• n some cases, attacks are aborted when the patient is called.
• The attack lasts from a few seconds to half a minute and evaporates as rapidly as it commenced.
• Absence seizures generally are not followed by a period of disorientation or lethargy (postictal state), in contrast to the majority of seizure disorders.

Types

Absence + Mild clonic components

• Here the onset of the attack is indistinguishable from the above, but clonic components may occur in the eyelids, at the corner of the mouth, or in other muscle groups which may vary in severity from almost imperceptible movements to generalised myoclonic jerks. Objects held in the hand may be dropped.

	EEE	VEE	HSV-1
Seizure
Coma
Jerking myoclinic

Absence + Atonic components

• Here there may be a diminution in tone of muscles subserving posture as well as in the limbs leading to dropping of the head, occasionally slumping of the trunk, dropping of the arms, and relaxation of the grip. Rarely tone is sufficiently diminished to cause this person to fall.

	PLV	CXA/ CXB/ ECHO	NPH
Seizure
Coma
Hypotonia

Absence + Tonic components

• Here during the attack tonic muscular contraction may occur, leading to increase in muscle tone which may affect the extensor muscles or the flexor muscles symmetrically or asymmetrically. If the patient is standing, the head may be drawn backward and the trunk may arch. This may lead to retropulsion, which may cause eyelids to twitch rapidly; eyes may jerk upwards or the patients head may rock back and forth slowly, as if nodding. The head may tonically draw to one or another side.^{[citation needed]}

	PLV
Seizure
Coma
Spasm

Absence + Automatisms

• Purposeful or quasi-purposeful movements occurring in the absence of awareness during an absence attack are frequent and may range from lip licking and swallowing to clothes fumbling or aimless walking. If spoken to, the patient may grunt, and when touched or tickled may rub the site. Automatisms are quite elaborate and may consist of combinations of the above described movements or may be so simple as to be missed by casual observation.

	JE	CXA/ CXB/ ECHO
Seizure
Coma
Choreathetosis

Absence + Autonomic components

• These may be pallor, and less frequently flushing, sweating, dilatation of pupils and incontinence of urine.

	TBE	SAHF	JE
Seizure
Coma
Orthostatic Hypotention		+++
Urine incontinence	+++
Dilated pupils			+++

Mixed forms of absence

• These seizures can happen a few times a day or in some cases, hundreds of times a day, to the point that the person cannot concentrate in school or in other situations requiring sustained, concentrated attention.