Absence Seizures are generalized seizures with brief lapses in attention and activity. 

Absence seizures seen in idiopathic and symptomatic generalized epilepsy cases, especially in childhood and juvenile absence epilepsy. 

Typical absence seizures are associated with 3 to 4 Hz spike and slow wave complexes on EEG. 

Frequent brief seizures in childhood absence epilepsy last for seconds, some shows multiple times seizures on daily basis these are called non-pyknoleptic or spanioleptic absence seizures. 

Absence seizures in cryptogenic/symptomatic generalized epilepsies are linked to slow spike waves with frequency of 1.5 to 2.5 Hz. 

Classification of absence seizures as follows: 

Typical and Atypical absence 

Myoclonic absence 

Eyelid myoclonia 

The incidence in the United States is 1.9 to 8 cases per 100,000 population and generalized idiopathic epilepsies have age-related onset. 

Absence seizures are more common in females. Majority of children with childhood absence epilepsy are girls. 

Disorders can start in early life, but absence seizures like Lennox-Gastaut syndrome develop later in childhood. 

Brief absence and myoclonic seizures may go unnoticed until a tonic-clonic seizure is developed. 

The pathophysiology of absence seizures is not fully understood.  Unusual rhythms in thalamocortical pathways arises due to GABA-B inhibition and glutamate excitation. 

T-type calcium in GABAergic reticular thalamic nucleus neurons is necessary for spike-wave discharges. 

Genetic causes play a role in idiopathic epilepsies with age-related onset in many patients. 

Family member may have different forms of epilepsy: e.g., febrile convulsions, seizures 

Idiopathic generalized epilepsies form a clinical spectrum with diverse genetic causes affect ion channels. Genetic research reveals syndromes as channelopathies with various gene mutations present. 

Mutations cause hyper glycosylation in vitro and reduce GABA current density from cells, that explains childhood absence epilepsy patterns. 

Long-term control of generalized tonic-clonic seizures needed before therapy discontinuation is considered for patients. 

80% of childhood absence epilepsy patients experience remission with medication. 

Juvenile myoclonic epilepsy patients may need lifelong treatment, but some manage with lifestyle adjustments. 

Juvenile myoclonic epilepsy has high risk of tonic-clonic seizures, despite good control with low AED doses. 

Absence seizures mostly occur in children between the ages group 4 and 14 years old. 

Medical History 

Observational Assessment 

Neurological Examination 

Absence seizures start suddenly, last for 10 to 20 seconds. They can be overlooked or confused with daydreaming due to their brief nature. 

Frequent daily seizures disrupt activities and learning, occurs hundreds of times. 

Start antiepileptic medication requires careful consideration due to potential toxicity, sedation, and cognitive effects. 

Children with absence seizures may require long-term or lifelong medication. 

FDA approves ethosuximide and valproic acid to be used for absence seizures treatment. 

Ethosuximide and valproic acid more effective than lamotrigine for childhood absence epilepsy, with fewer side effects. 

Clonazepam and ketogenic diet used to reduce seizure frequency attempts. Levetiracetam helps with tonic-clonic seizures but is less effective for absence seizures. 

Topiramate FDA approved as initial monotherapy for children over 10 years old with generalized seizures 

Consider folic acid 1 to 4 mg daily before conception for women on antiseizure agent, prefer monotherapy and lowest effective dose. 

Neurology

Consider ketogenic or medium-chain triglyceride diet for seizures. Refer children to centre with specialized dietary services for potential diets. 

Limit restrictions on physical activity to necessary precautions; activities with seizure risk can be done with supervision. 

Child with epilepsy should not have unnecessary limitations; uncontrolled absence seizures restrict driving. 

Therapy aims to fully control seizures with minimal medication for fewer side effects. 

Proper education and awareness about absence seizures should be provided and its related causes with management strategies. 

Appointments with a neurologist and preventing recurrence of disorder is an ongoing life-long effort. 

Neurology

Ethosuximide: 

It inhibits T-type calcium channels in thalamic neurons to reduce the abnormal electrical activity. 

Valproic Acid: 

It increases the availability of gamma-aminobutyric acid in the brain to enhance inhibitory neurotransmission. 

Neurology

Clonazepam: 

It enhances GABAergic inhibition that binds with benzodiazepine receptors. 

Neurology

Interventions for absence seizures involve medical and behavioral strategies, but there are no specific surgical procedures for the treatment of this type of seizures.  

Neurology

In the initial diagnosis phase, evaluation of history of the seizure episodes, including frequency and duration to confirm diagnosis. 

Pharmacologic therapy is very effective in the treatment phase as it includes use of anticonvulsants and benzodiazepines. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation. 

The regular follow-up visits with the neurologist are schedule to check the improvement of patients along with treatment response.