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Absence Seizures .. Dr Padmesh

Absence Seizures in Children

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Absence Seizures .. Dr Padmesh

  1. 1. Absence Seizures Dr.Padmesh. V
  2. 2. • Typical absence seizures have a bimodal distribution for age of onset; • First peak at 5-8 years (childhood) • Second peak near 12 years of age (juvenile)
  3. 3. • Childhood Absence Epilepsy (CAE) • CAE is a childhood epilepsy syndrome occurring in 10–17% of all childhood onset epilepsy. • The most common pediatric epilepsy syndrome. • Females > males
  4. 4. • Usually start at 5-8 yr of age. • No aura. • Usually last for only a few seconds.
  5. 5. • Accompanied by eye lid flutter or upward rolling of eyes. • Absence seizures can have simple automatisms like lip-smacking or picking at clothing. • Head can minimally fall forward. • No postictal period.
  6. 6. • Hyperventilation for 3-5 min can precipitate the seizures and the accompanying 3 Hz spike–and– slow-wave discharges.
  7. 7. • EEG: • The ictal EEG of a typical absence seizure demonstrates: • generalized spike and wave complexes • that are > 2.5 Hz, typically 3–4.5 Hz , and • lasting ≥ 3 seconds. 3/sec spike-and-wave discharge of absence seizures with normal background activity
  8. 8. • The presence of periorbital, lid, perioral or limb myoclonic jerks with the typical absence seizures usually predicts difficulty in controlling the seizures with medications.
  9. 9. • Early onset absence seizures (before 4 yr) Evaluate glucose transporter defect that is often associated with low CSF glucose levels and an abnormal sequencing test of the transporter gene.
  10. 10. • Atypical absence seizures : • Associated myoclonic components. • Tone changes of the head (head drop) and body. • Variable impairments of consciousness. • Last longer than typical absences. • Precipitated by drowsiness. • Not provoked by hyperventilation or photic stimulation. • Usually more difficult to treat. • 1-2 Hz spike–and–slow-wave discharges.
  11. 11. • Juvenile absence seizures: • Similar to typical absences. • But occur at a later age. (10-17 years) • Accompanied by 4-6 Hz spike–and–slowwave and polyspike–and–slow-wave discharges. • Usually associated with juvenile myoclonic epilepsy
  12. 12. • TREATMENT: • Initial treatment: Ethosuximide (less toxic than valproate and more effective than lamotrigine.) • Alternative drugs of first choice are lamotrigine and valproate, especially if generalized tonic–clonic seizures coexist with absence seizures. (as these 2 medications are effective against the latter seizures whereas ethosuximide is not.) • EEG often normalizes when complete seizure control is achieved.
  13. 13. • TREATMENT: • Other medications that could be used for absence seizures include – Acetazolamide, – Zonisamide, or – Clonazepam.
  14. 14. • Outcome and Prognosis of Childhood Absence Epilepsy • Remission rates : 21%–74% • Although labeled “benign”, the clinical course of CAE is variable and remission rates are far lower than in other classic benign idiopathic epilepsies such as Benign Rolandic Epilepsy. • Multiple studies report that GTCs ultimately develop in roughly 40% of children with absence seizures at onset.
  15. 15. • Outcome and Prognosis of Childhood Absence Epilepsy • GTCs often occur 5 to 10 years after the onset of the absence seizures between 8–15 years old. • Risk factors include: – Onset of absence seizures after 8 years old, – Male sex, – Lack of response to initial therapy and – Therapy with only an anti-absence drug. • Accidental injury is common.
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