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An absence seizure, formerly called petit mal, is a very special and uncommon type of seizure. It starts suddenly and without warning. The child assumes a glazed look and stares. She doesn’t know what is happening and usually cannot recall things that occurred during the seizure. Occasionally, there is a little eye-blinking or head-bobbing. The episode usually lasts just seconds, occasionally as long as fifteen seconds, and ends just as abruptly as it started. When the seizure ends, the child is immediately alert. There is no confusion afterward. These seizures may occur many times a day and are often mistaken for daydreaming.
It is usually easy for the physician to produce an absence seizure in his office by making such a child take deep breaths. Usually fifteen to thirty deep breaths (hyperventilation) will produce a typical spell. (Don’t worry, exercise, such as running, swimming, or bike riding, which may make someone “out of breath,” does not produce one of these spells.)
A parent may only see a few seizures because the brain’s activity must be interrupted for more than one second before a spell is apparent. Thus, very brief electrical events (less than one second in duration) are observable only on the EEG. But, in a sense, the child’s awareness may be being interrupted frequently, and the child may miss some of what is going on around him.
Occasionally a person with these spells describes life “like a movie in which brief segments have been cut out.” Teachers describe the child as daydreaming. Friends may call the child “spacey.”
Atypical absence seizures are similar to absence seizures, but may have more pronounced motor symptoms, such as tonic or clonic spells, or may have automatisms as seen in complex partial seizures. The EEG does not have the classic three-per-second spike and wave pattern seen in simple absence seizures. Atypical absence seizures are more commonly seen in children with a damaged nervous system and are often associated with other types of seizures.
Absence seizures may superficially be confused with complex partial seizures because both involve staring. Since they both may require different treatments and have different outcomes, the differentiation may be important.
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