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Typical absences (previously known as petit mal) are generalised seizures that are distinctively different from any other type of epileptic fit.1 They are pharmacologically unique2-5 and demand special attention in their treatment.6
The prevalence of typical absences among children with epilepsies is about 10%, probably with a female preponderance.6 Typical absences are easy to diagnose and treat. Therefore, it is alarming that 40% of children with typical absences were inappropriately treated with contraindicated drugs, such as carbamazepine and vigabatrin, according to a recent report from London, UK.7
The purpose of this paper is to offer some guidance to paediatricians regarding diagnosis and management of typical absence seizures. This is also important because of the introduction of new antiepileptic drugs. These are mainly tested in partial (focal) epilepsies and there are inappropriate generalisations regarding their use in the treatment of other epilepsies.
Typical absence seizures
Typical absence seizures are defined according to clinical and electroencephalogram (EEG) ictal and interictal expression.1 6 Clinically, the hallmark of the absence is abrupt and brief impairment of consciousness, with interruption of the ongoing activity, and usually unresponsiveness. The seizure lasts for a few to 20 seconds and ends suddenly with resumption of the pre-absence activity, as if had not been interrupted. Although some absence seizures can manifest with impairment of consciousness only, this is often combined with the following:
mild clonic jerks of the eyelids, corner of the mouth, or other muscles
atonic components leading to drooping of the head, slumping of the trunk, dropping of the arms, and relaxation of the grip
tonic muscular contraction causing head retropulsion or arching of the trunk
automatisms that are common and range from lip licking and swallowing to fumbling with clothes or aimless walking
autonomic components, such as pallor, and less frequently flushing, sweating, …
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