Absence seizures are benign, generalized seizures thought to originate subcortically. They involve brief episodes of unconsciousness, typically lasting 3–20 seconds, and may occur 100 or more times per day, causing frequent lapses in attention.

These seizures usually begin between ages 4 and 12. Early signs may include deteriorating school performance and behavioral changes. The exact cause is unknown.

Pathophysiology

• Thought to involve abnormal thalamocortical circuits, producing synchronous spike-and-wave discharges on EEG.

• Brief interruption of conscious awareness occurs without postictal confusion.

• May involve mild automatisms or subtle myoclonic movements (eyelid jerks, lip smacking).

History and Physical Examination

History:

• Sudden onset of staring spells with abrupt interruption of activity

• Duration: usually 3–20 seconds

• Frequency: may occur multiple times per day

• Associated automatisms: lip smacking, eyelid fluttering, mild clonic movements

• Family observations: inattention, dropping objects, head slumping

• Academic or behavioral deterioration

Physical examination:

• Patient is alert and normal between seizures

• Neurologic exam is usually normal

• Observe for automatisms during events

• Assess cognitive and behavioral function

Clinical test:

• Ask patient to count or recite numbers. During an absence seizure, they will pause and resume afterwards.

Medical Causes

Special considerations

• Prepare for diagnostic testing: EEG (essential), CT scan, MRI if atypical features

• Administer anticonvulsants as prescribed

• Ensure safe environment to prevent injury during seizures

• Provide emotional support to patient and family

Patient counseling

• Explain warning signs requiring urgent attention (e.g., prolonged seizure, injury risk)

• Emphasize adherence to follow-up care and medication

• Include teachers and school nurses in education to monitor episodes

• Recommend medical identification (bracelet or card)

Pediatric pointers

• Common in school-aged children (4–12 years)

• Early recognition is key to prevent academic or social difficulties

• Seizures are usually benign and self-limited

References

1. Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. USA: American Academy of Pediatrics; 2012.

2. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008.

3. Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.