Authors: Praveen Kumar Ramani, MBBS, University of Arkansas, Arkansas Children’s Hospital Sreenath Thati Ganganna, MD, MBBS, University of Iowa, Stead Family Children’s Hospital, Iowa City, IA 

Reviewed: September 2023 

SUMMARY 

Absence seizures are a common seizure type in children. They can occur as part of several childhood epilepsy syndromes. They make up 10 to 17% of all childhood epilepsies. 

Absence seizures are characterized by a brief lapse in awareness. There is no obvious shaking or jerking of the body. However, there may be subtle rhythmic movement of the eyebrows, head, or mouth.  

Seizures are generally brief. On average, they last less than ten to fifteen seconds. They start and end abruptly. Seizures tend to occur multiple times in a day.   

Sometimes, absence seizures are confused with focal seizures. The two conditions have similar features. For example, they both involve: 

• Staring 
• Unresponsiveness to stimulation 
• Loss of awareness 

However, focal seizures tend to last longer. They may also present with stiffening or jerking of extremities on one side.  

After a focal seizure, patients are usually tired and sleepy. They may also be nauseous. Additionally, they may have aura symptoms at the beginning of the focal seizure. (This is discussed later in the section titled “Related Disorders.”) 

The two most common types of absence epilepsy are: 

• Childhood absence epilepsy (CAE) 
• Juvenile absence epilepsy (JAE) 

Females are more often affected than males. Compared to other epilepsy syndromes, there is also more commonly a family history of seizures.  

When part of CAE, seizures are usually well controlled with anti-seizure medication. However, some may be more challenging to control.  

Most children with CAE will ultimately reach an age when their absence seizures stop. This is typically by adolescence or adulthood. People with JAE may need to continue treatment into adulthood. 

Besides CAE and JAE, absence seizures can occur in other epilepsy syndromes. These include:  

• Jeavons syndrome (eyelid myoclonia with or without absence seizures) 
• Myoclonic absence epilepsy 

Patients may also experience a less common type of seizure called an atypical absence seizure. Conditions with atypical absence seizures include:  

• Lennox-Gastaut syndrome 
• Dravet syndrome  
• Doose syndrome (epilepsy with myoclonic-atonic seizures) 
• Brain tumors 
• Other brain diseases 

Disorder Overview

DESCRIPTION

There is also a less common type of absence seizure called an atypical absence seizure. These are usually seen in epilepsies that involve: 

• Seizures that are harder to treat 
• Developmental delay 

Atypical absence seizures tend to last longer than typical absence seizures. Atypical absence seizures can last up to twenty seconds or more. The start and end of them is somewhat vague.  

During atypical absence seizures, the patient may also experience:  

• Loss of muscle tone 
• Body stiffening 
• Eyelid fluttering 
• Eye deviation (atypical movement) 

SIGNS AND SYMPTOMS

Symptoms depend on the type of seizure. There are two types of seizures most seen in CAE or JAE: 

Atypical absence seizures appear slightly differently on an electroencephalogram (EEG) compared to typical absence seizures.  

CAUSES

Absence seizures and generalized tonic-clonic seizures are caused by abnormal electrical activity in the brain. 

Genetics are thought to play a significant role. Some genes have been linked to this condition. It is unknown how this condition is inherited. 

Some things can trigger seizures. Triggers include: 

• Rapid or heavy breathing (also called hyperventilation) 
• Lack of sleep 
• Flashing lights 
• Not taking anti-seizure medication appropriately 

LABORATORY INVESTIGATIONS

Diagnosis of seizures is mostly clinical. Your doctor will get a detailed history of the episode. They will perform a complete neurological examination. They will try to identify: 

• The type of seizure 
• Warning signs 
• Triggering factors 

Your doctor will most likely perform an electroencephalogram (EEG). This is used to confirm the diagnosis. 

An EEG measures the electrical activity of the brain. Stickers (electrodes) are placed on the scalp. It usually takes between thirty minutes and an hour to complete. 

Hyperventilation (rapid breathing) can trigger absence seizures. Your child may be instructed to blow repeatedly at a pinwheel for one or two minutes during the EEG test. The doctor will see if it provokes a seizure. This can confirm the diagnosis. 

Magnetic resonance imaging (MRI) of the brain is usually not required in a patient with CAE or JAE. It may be needed if there are atypical or abnormal findings on the neurological examination. These could suggest the possibility of an alternative diagnosis. 

TREATMENT AND THERAPIES

Once absence seizures are diagnosed, patients are treated with anti-seizure medication.  

There are also alternative treatment options. These can help if a patient has a medication-resistant type of absence epilepsy. Some options include: 

• A ketogenic diet. This is a low-carb, high-fat diet. 
• Vagus nerve stimulation (VNS). Electrical pulses are sent to the vagus nerve.  

Your doctor will choose the most appropriate medication based on: 

• The specific type of absence epilepsy 
• The age of the patient 
• Symptoms 
• Any associated medical conditions 

Children with absence seizures often have increased risk of: 

• Attention problems 
• Low self-esteem 
• Depression 
• Social isolation 

Early recognition of these symptoms is important. So is timely intervention with appropriate therapies. 

The child’s teacher and school nurse should be notified of their condition. Providing the school staff with a seizure action plan will be helpful. This plan should include recommendations from your neurologist. 

Special precautions need to be taken with driving. Each state has different driving laws for people with epilepsy. Overall, if the patient continues to have any type of seizure associated with loss of awareness, it is not safe to drive. Your neurologist should be able to give you more state-specific details during your clinic appointment. 

These are some other general safety recommendations for those with absence seizures: 

• Do not take a bath or swim alone. (Showers are okay.) 
• Avoid excessive unrestrained heights. 
• Avoid going close to fire. Activities involving sharp objects will need supervision. 
• Avoid identifiable triggers. 

OUTLOOK

Children with CAE or JAE can live normal lives. In most cases, there is no developmental delay. Intelligence is typical. 

Most often, seizures are well controlled. Children with CAE do not require lifelong treatment. Studies have shown that 57 to 74% of patients become seizure-free when they are older. 

Some factors are associated with increased difficulty in controlling seizures. These include: 

• Early onset. Seizures start when the child is four years old or younger. 
• Generalized tonic-clonic seizures. With generalized tonic-clonic seizures, a person loses consciousness. Their muscles also jerk.  
• Developmental delays. 

Some patients continue to have absence seizures that are resistant to medication. Up to 40% of them are at risk of developing generalized tonic-clonic seizures. 

In about a third of patients, behavioral problems continue despite good control of seizures. 

Most children with JAE respond well to medication. However, they will need lifelong treatment. This is because the risk of seizure recurrence is high after weaning off medication. 

SUDEP is the sudden, unexpected death of a patient with epilepsy. The cause is not known. People with absence or myoclonic seizures are generally not known to have an increased risk for SUDEP. For more information on this topic, see our SUDEP Resource page. 

RELATED DISORDERS

Related disorders include: 

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Kessler SK, McGinnis E. A Practical Guide to Treatment of Childhood Absence Epilepsy. Paediatr Drugs. 2019 Feb;21(1):15-24. https://doi.org/10.1007/s40272-019-00325-x. PMID: 30734897; PMCID: PMC6394437. 

The information in the CNF Child Neurology Disorder Directory is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. Content provided is for informational purposes only. CNF is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options.