Childhood absence epilepsy
The Epilepsy Foundation states that childhood absence epilepsy accounts for two to eight percent of patients with epilepsy with seizures usually beginning between ages 4 and 8 in children who have normal intelligence and neurologic function. By gaining an understanding of this relatively benign childhood epilepsy you can inform other families and do a better job at helping your child. Dr. Ajay Gupta, section head of pediatric epilepsy at the Cleveland Clinic took the time to go over some of the basics on the condition.
Q. How do you identify absence epilepsy?
A. Children can have seizures where there is a behavior arrest [when someone undergoes temporary total-body arrest of movement] which parents would see if the child stops doing an activity they are involved in like playing with a toy, walking or bicycling, then staring off in space for 10, 15 or 20 seconds and going back to what they were doing before they had the seizure. It can happen at school, on the playground or at home. Since it looks like they are absent from the world it is called an absent seizure, but the name in the old literature is petit mal epilepsy meaning small seizures.
Q. Is absence epilepsy genetic?
A. It is not an inherited condition so most commonly you would only find one child in a family with absent seizures. Only in a small minority it can be a genetic condition where we can make a diagnosis doing gene testing. Slightly more girls have it than boys.
Q. How is the condition diagnosed?
A. The best way to diagnose is doing a test called EEG where you put electrodes on your head and record by a machine for 30 minutes to an hour. Typically you will find changes in brain waves that help you confirm a diagnosis. Sometimes you are lucky to record a seizure or absent seizure during that time but even if you do not record a seizure there is enough in the brain waves to tell us if the child has absent seizures.
Q. How does absence epilepsy affect daily living?
A. Often brain function is interrupted by the seizures many times a day so if the child is in kindergarten or first grade and supposed to be paying attention in the class, writing or reading he may fall behind the other kids. Sometimes there is a small risk of injury because if they are in a situation where they are not supposed to stop and they stop, they can fall, trip or somebody can hit them.
Q. What is treatment?
A. As soon as you are diagnosed and it is confirmed to be absence epilepsy typically it is recommended to go on medication for 2 to 3 years. The idea is that with medication the seizures are controlled and you can resume normal activities, go to school and learn. Kids should be encouraged that with a pill or liquid medication in the morning and evening they will do fine and to know that they will be followed by a neurologist as frequently as 3 months but usually 6 to 12 months for 2 to 3 years before either they are off medication or get on a plan where they have longer-term follow up.
Q. Is there anything new and exciting to manage absence epilepsy?
A. We have some newer treatment options. For children that do not get better with first or second line treatment medications we have special dietary treatment.
Q. What can you do for prevention?
A. There is no prevention and there have been no risk factors identified.
Q. Can you outgrow absence epilepsy?
A. About 50 to 60 percent outgrow it after the age of 8 or 9, but some patients do not grow out of it and have to take the medication for a longer period of time.
Q. Any advice to parents?
A. If your child has any of these episodes he should be checked out and most of these children can really be treated very well. If there is a child who continues to have such epilepsy despite being treated adequately it is important that they look deeply into other causes and sometimes a referral to a higher level epilepsy center may be necessary to see if they have a genetic condition or something that is not absence epilepsy but behaving like it.