Childhood Absence Epilepsy

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Introduction
What is Childhood Absence Epilepsy and what causes it?
What are the symptoms?
How is it diagnosed?
What is the prognosis?
What is the risk for other family members or future babies?
What treatments/therapies/medications are recommended or available?
How will my child and our family be impacted?
My son really wants to go to sleepovers with his friends, but we've noticed that when he doesn't get a good night of sleep he has more absence seizures the next day, despite his medication. Is this common?
My daughter has been seizure-free (petit mal or absence seizures) for more than a year but then had a generalized tonic-clonic seizure out of the blue. She is on ethosuximide and I was told her blood level was good just a week or two before the seizure. Why did this happen?
Every time my child gets a fever she seems to have more seizures. Why?

Introduction

Here you’ll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in the Childhood Absence Epilepsy module, which is written for primary care clinicians but also may be of help to parents and family members.

What is Childhood Absence Epilepsy and what causes it?

Childhood absence epilepsy (CAE) is a form of genetically-determined, generalized epilepsy that is characterized by absence seizures and, in 10% of cases, generalized tonic-clonic seizures. Absence seizures start between the ages of 4 and 10 years of age with the peak age of occurrence 6 to 7 years. Seizures occur many times a day.

What are the symptoms?

Characteristics of an absence seizure:

The child stares, sometimes blinks, eyes may begin to roll back
The seizure lasts 2-20 seconds, but usually less than 10 seconds
Abruptly INTERRUPTS ACTIVITY (such as drinking from cup, playing)
The child isn't aware of surroundings, such as being called by name
The child experiences many a day, sometimes up to 100/day
The child has no warning, seizure begins and ends suddenly
Absence seizures are evoked by continuous hyperventilation for 2-3 minutes

How is it diagnosed?

CAE is diagnosed based on the description of the seizure and confirmed by findings on an electroencephalogram (EEG). Your medical provider may ask your child to hyperventilate; this often leads to an absence seizure. An EEG looks for abnormal electrical discharges in the brain that may signal seizure activity. Absence seizures have a typical pattern on an EEG.

What is the prognosis?

Most children with CAE stop having seizures in adolescence; good prognostic signs are earlier age at onset and absences as the only seizure type (no generalized tonic clonic seizures). The recurrence risks after antiepileptic treatment withdrawal in children who have been seizure free for two years is 16%.

What is the risk for other family members or future babies?

Although CAE is inherited, the genetics are complex and due to multiple causes. A family member has a slightly higher risk of exhibiting seizures of various types compared to an individual in the general population.

What treatments/therapies/medications are recommended or available?

Several medications are available to treat CAE. See Childhood Absence Epilepsy.

How will my child and our family be impacted?

Children with CAE usually stop having seizures with medication, and generally medication can be discontinued after two years of seizure free time. However, children with CAE have a higher risk than children in the general population of having learning, mood, and behavior disorders. These should be diagnosed and treated promptly.

My son really wants to go to sleepovers with his friends, but we've noticed that when he doesn't get a good night of sleep he has more absence seizures the next day, despite his medication. Is this common?

Yes, a lot of families have noticed this. You might want to discuss sleep hygiene with your Medical Home provider to optimize sleep when he isn't on sleepovers, and then work with your son and the family he would visit for the sleepover to see if you could work out a sleepover with sufficient sleep.

My daughter has been seizure-free (petit mal or absence seizures) for more than a year but then had a generalized tonic-clonic seizure out of the blue. She is on ethosuximide and I was told her blood level was good just a week or two before the seizure. Why did this happen?

Although ethosuximide is an excellent medication for absence seizures, it doesn't prevent generalized tonic clonic seizures which can happen in children with absence epilepsy. You should let your Medical Home provider or neurologist, depending on your child's seizure plan, know about the new seizure type and he/she might recommend starting another medication.

Every time my child gets a fever she seems to have more seizures. Why?

Fevers, and illness in general, lower seizure threshold in children with epilepsy. Breakthrough seizures should be discussed with your Medical Home provider who may recommend increasing the medication dose to a level that will protect your child even during illness.

Resources

Information & Support

Where can I go for further information?

For Parents and Patients

Support

Childhood Absence Epilepsy (Epilepsy Foundation)
National organization with local chapters that provides information and support.

Epilepsy Association of Utah
For individuals with epilepsy, families, and friends, this site offers newsletters, events, links, local and youth support groups, activities for kids, first aid for seizures, and more.