Childhood Absence Epilepsy

Abstract

Absence epilepsy is a common primary generalized epilepsy that involves thalamocortical pathways in the generation and sustenance of absence seizures. The EEG signature of absence epilepsy is a 3 Hz generalized spike-and-wave discharge occurring in the context of a normal background that may or may not be activated by hyperventilation and sleep. Depending on the age of presentation, there are two varieties of absence epilepsy. Childhood absence typically appears at age 3 and disappears by age the pre-teen years. Juvenile absence epilepsy typically presents in early teenage years and has a 50% chance of disappearing by early adulthood. Another pivotal difference between the two is that juvenile absence epilepsy is associated with generalized tonic-clonic seizures. Effective treatment requires a prompt diagnosis and understanding of medications that are likely to be effective. Generally sodium channel medications are avoided since they may exacerbate absence seizures. Ethosuximide, while very effective for childhood absence, may not be effective against generalized tonic-clonic seizures, and a broad-spectrum agent should be considered for juvenile absence epilepsy.