Petit Mal Epilepsy

Petit mal epilepsy, now known as absence seizures, causes brief episodes where a person suddenly stares blankly and loses awareness for just a few seconds, often going unnoticed by observers and sometimes mistaken for daydreaming.

absence seizures, absence epilepsy, childhood absence epilepsy

Table of contents

• What is Petit Mal Epilepsy?
• Symptoms and Characteristics
• Causes and Risk Factors
• How is it Diagnosed?
• Treatment Options
• Outlook and Prognosis

What is Petit Mal Epilepsy?

Petit mal epilepsy, now commonly called absence seizures or childhood absence epilepsy, is a type of epilepsy (a brain disorder that causes repeated seizures) that primarily affects children. A seizure happens when there is a sudden change in the electrical activity of the brain, causing it to send incorrect signals.^[1]

These seizures involve brief, sudden lapses of consciousness that typically last between 3 and 15 seconds, though they may extend to about 30 seconds.^[1][2] During an absence seizure, the person appears to stare blankly into space and becomes completely unresponsive to their surroundings. They are more common in children than in adults.^[1]

The condition is called a generalized seizure because it affects the entire brain rather than just one area.^[6] Absence seizures affect an estimated 6 to 8 out of every 100,000 children younger than 15 years old each year.^[2] They account for about 10 to 17 percent of all children with epilepsy.^[10]

Seizures usually begin between 4 and 10 years of age, with the highest occurrence around 6 to 7 years old.^[10] The condition occurs slightly more often in girls than in boys.^[10][11]

Symptoms and Characteristics

The main symptom of petit mal epilepsy is a sudden, brief interruption in consciousness. During an absence seizure, a person will stop whatever activity they were doing without any warning.^[1] The most common signs include:^[1][2]

• A vacant stare or blank look
• A sudden stop in movement, talking, or other activity
• Loss of awareness of surroundings
• Rapid eyelid fluttering or blinking
• Lip smacking
• Chewing motions
• Small finger or hand movements, such as finger rubbing

After the seizure ends, the person typically returns immediately to normal activity and has no memory of what happened during the episode.^[1] There is usually no confusion, headache, or drowsiness afterward.^[1]

Without treatment, these seizures can happen very frequently. Some people experience many episodes daily, with some children having 50 to 200 absence seizures in a single day.^[3][11] When seizures occur this often, they can seriously interfere with a child’s ability to pay attention in school or participate in daily activities.^[1]

Because the seizures are so brief and subtle, they can be easily overlooked. Teachers or parents may be the first to notice that something is wrong, often thinking the child is simply daydreaming or not paying attention.^[1] A decline in a child’s learning ability may sometimes be the first sign of the disorder.^[1]

Causes and Risk Factors

Absence seizures are caused by a burst of abnormal electrical activity in the brain. The neurons (nerve cells) receive incorrect instructions and send too many electrical signals to different parts of the brain.^[2]

The underlying cause is thought to be largely genetic, meaning it can run in families. About one in three children with childhood absence epilepsy have a family history of similar seizures.^[3][11] Researchers believe that several genes may play a role in the condition, though the genetic patterns are complex and not fully understood.^[11] The siblings of affected children have an estimated 1 in 10 chance of also developing the condition.^[11]

Certain factors can trigger absence seizures in people who are prone to them. Common triggers include:^[2]

• Bright or flashing lights
• Breathing deeply and rapidly (hyperventilating)

Seizures are more likely to occur when a child is bored, tired, or not engaged in an activity. They become less likely when a child is concentrating on something.^[4]

How is it Diagnosed?

Childhood absence epilepsy can often be diagnosed during a regular office visit with a careful medical history, physical examination, and routine tests.^[10] The doctor will ask for a detailed description of the seizures, including how often they occur and how long they last.^[3]

A key diagnostic test is the electroencephalography or EEG, which is a painless procedure that measures waves of electrical activity in the brain.^[8] Small metal plates called electrodes are attached to the scalp to record brain wave patterns. During an absence seizure, the EEG shows a highly recognizable pattern of generalized (affecting both sides of the brain) 3 Hz spike and wave discharges.^[10]

During the EEG test, the doctor may ask the child to hyperventilate (breathe quickly) for three to four minutes, as this can trigger an absence seizure and help confirm the diagnosis.^[8][11] In 90 percent of cases, this test can provoke a seizure.^[11]

Brain imaging tests, such as MRI (magnetic resonance imaging) scans, may also be performed to rule out other conditions such as a stroke or brain tumor.^[8] The doctor will also review the child’s medical history, including any history of birth trauma or serious head injury, and may ask about family history of epilepsy.^[3]

Treatment Options

Absence seizures can usually be managed effectively with antiseizure medicines (also called anticonvulsants), which are medications that help control abnormal electrical activity in the brain.^[1][8]

The most commonly prescribed medications for absence seizures include:^[8][12]

• Ethosuximide (Zarontin): This is often the first medicine prescribed for absence seizures when they occur alone. Most people see improvement in their seizures with this medication.
• Valproic acid (Depakene) or divalproex sodium (Depakote): These medications are also effective, though they may have more side effects than ethosuximide.
• Lamotrigine (Lamictal): This is another treatment option, though studies suggest it may be somewhat less effective than ethosuximide.

When compared to each other, ethosuximide is considered the treatment of choice for childhood absence epilepsy with absence seizures only. Valproic acid has more adverse effects, and lamotrigine is less effective.^[10]

The healthcare provider typically starts at the lowest dose of medication possible, then increases the dose as needed to control the seizures.^[8] Some children may be able to stop taking antiseizure medicines after being seizure-free for two years, but this should only be done under medical supervision.^[8]

Some sources mention that certain nutrients may help reduce seizure frequency, including vitamin B6, magnesium, vitamin E, manganese, taurine, and omega-3 fatty acids, though more research is needed.^[12]

Outlook and Prognosis

The outlook for children with petit mal epilepsy is generally positive. Many children outgrow absence seizures during their teenage years.^[1] With proper medication, seizures can usually be well controlled.^[11]

However, some children who have absence seizures may also develop other types of seizures, such as generalized tonic-clonic seizures (formerly called grand mal seizures) or myoclonic seizures (brief, jerky muscle movements).^[1] In these cases, ongoing treatment and monitoring are important.

While absence seizures themselves usually do not lead to physical injury because they are so brief and the person typically does not fall, they can still pose risks in certain situations. Injury can happen if someone is driving a car, riding a bike, swimming, or engaged in other activities when the seizure occurs.^[1]

Seizures are unlikely to impact a child’s overall development. However, children who experience a high frequency of seizures may develop some learning difficulties because the repeated brief interruptions can interfere with their ability to pay attention in class and absorb information.^[4]

If your child has experienced more than one seizure or shows signs of absence seizures, it is important to see a healthcare provider for proper evaluation and treatment. With appropriate medical care and medication, most children with petit mal epilepsy can lead normal, active lives.