Absence seizures — previously referred to as petit mal seizures — cause staring spells that typically last less than 15 seconds. They are caused by abnormal electrical activity in the brain that results in a temporary loss of awareness, which can sometimes be mistaken for daydreaming or inattention, especially in childhood, though these seizures also can continue into adulthood.
UPMC epilepsy experts provide advanced care for absence seizures, including first line treatment with anti-seizure medications. If seizures continue despite medications, our neurologists will work with our neurosurgery experts to discuss surgical options to reduce seizure activity.
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What Are Absence Seizures?
Absence seizures — previously referred to as petit mal seizures — cause staring spells that typically last less than 15 seconds. They are caused by abnormal electrical activity in the brain that results in a temporary loss of awareness, which can sometimes be mistaken for daydreaming or inattention, especially in childhood, though these seizures also can continue into adulthood.
What are the types of absence seizures?
There are two types of absence seizures, including:
- Typical absence seizures — The most common type of absence seizure. Typical absence seizures cause brief, 10 to 20 second spells of staring, stopping all activity, rapid or abnormal eye movements, and temporary confusion.
- Atypical absence seizures — These seizures last a bit longer, with most lasting five to 30 seconds, involve different symptoms, and come on and leave slower than typical absence seizures. Symptoms can include staring, rapid or abnormal eye movements, mouth movements such as lip smacking or chewing motions, and hand motions such as rubbing fingers together. Awareness is lost during these seizures, but patients may not necessarily stop all activity during them.
How common are absence seizures?
Absence seizures are common in childhood and affect six to eight of 100,000 children under age 15. Although absence seizures can continue in older teens and adults, they are less common.
What causes absence seizures?
All epileptic seizures are caused by abnormal electrical activity in the brain.
What triggers absence seizures?
Absence seizures may be triggered by bright, flashing lights or fast, deep breathing (hyperventilation).
Absence seizure risk factors
You may be at higher risk for absence seizures if you:
- Are younger than age 15.
- Have a family history of seizures.
- Have been diagnosed with another type of seizure.
- Take certain antiseizure medications.
Complications of absence seizures
Absence seizures may cause complications, including:
- Inability to drive, swim, or engage in other activities that require your full attention.
- Injuries due to falls and other accidents.
- Learning challenges in school.
- Difficulty paying attention or following directions.
Other serious complications of absence seizures may include:
- Status epilepticus — Long-lasting seizures or seizures that occur one after another.
- Sudden unexplained death in epilepsy (SUDEP) — A rare condition that causes sudden death without a clear cause in people with epilepsy, often during sleep.
How can I prevent absence seizures?
There is nothing you can do to prevent absence seizures from occurring initially. After diagnosis, you may be able to reduce your risk of future seizures and decrease the frequency of seizures by avoiding known triggers, taking your prescribed medication as directed, getting enough sleep at night, avoiding alcohol and non-prescribed recreational drugs, avoiding dehydration, and letting your provider know if your seizures change or worsen.
What Are the Signs and Symptoms of Absence Seizures?
Absence seizures can happen several times a day, or only occasionally over a period of weeks or months.
Symptoms of an absence seizure may include:
- Brief, sudden spells that look like a blank stare.
- Hand movements, such as rubbing fingers together.
- Head nodding.
- Loss of awareness.
- Mouth movements, such as lip smacking or chewing motions.
- Rapid eyelid fluttering.
- Stopping all activities, such as walking, typing, or talking.
After the seizure is over, you may:
- Feel like you missed events occurring around you.
- Not notice anything, including loss of awareness.
- Resume the activity you were doing before the seizure.
Are you aware during an absence seizure?
No. Absence seizures cause brief, temporary losses of awareness.
How long does an absence seizure last?
Typical absence seizures last three to 15 seconds, and atypical absence seizures usually last 20 seconds or longer. They can often be mistaken for daydreaming or inattention, especially in children.
When should I see a doctor about my absence seizure symptoms?
If you are having symptoms of absence seizures, you should schedule an appointment with your provider right away. If your seizure symptoms are severe or occur one right after another, dial 911 or ask someone to take you to the nearest hospital Emergency Department.
How Do You Diagnose Absence Seizures?
To diagnose absence seizures, your provider will perform a physical examination and review your symptoms and medical history. Your provider may also order tests to confirm your diagnosis or rule out other problems.
What to expect during your visit
During your visit, your provider will:
- Ask you about your symptoms.
- Order tests.
- Perform a physical and neurological exam.
- Review your medical history.
Tests to diagnose absence seizures
Your doctor may order tests to confirm your diagnosis or rule out other conditions, including:
- Blood tests — Checks for infections and abnormalities.
- Electroencephalogram (EEG) — Checks for abnormal electrical activity in your brain that may cause seizures.
- Hyperventilation test — Involves blowing on a paper pinwheel for two minutes in attempt to cause hyperventilation that triggers an absence seizure.
- Magnetic resonance imaging (MRI) — Creates images of your brain to look for damaged or abnormal areas.
- Video-EEG monitoring — Uses EEG in combination with video monitoring to capture physical symptoms during seizures or episodes of concern.
- Neurological examination — A noninvasive physical exam to check your reflexes, balance, movement, memory, and ability to think.
Absence seizure prognosis
Absence seizures can affect learning and the ability to focus on tasks, which can impact quality of life, safety, and performance at school or work. Many children outgrow absence seizures by adolescence, though some have persistent absence seizures into adulthood.
How Do You Treat Absence Seizures?
The goals of absence seizure treatment are to prevent seizures, minimize treatment-related side effects, and improve quality of life. Treatment options may include:
Lifestyle changes
If you and your epilepsy care team can identify triggers that lead to absence seizures, you may be able to make lifestyle changes to reduce the number of seizures you experience.
Dietary changes
Your provider may recommend following a specialized, high-fat, low-carbohydrate diet, such as the ketogenic diet, to help manage seizures in certain circumstances.
Medications for epilepsy
Medications are the first-line treatment and help to control them in most people with epilepsy. Your provider will work with you to identify the medications, or combination of medications, that work best for you with minimal side effects.
Surgery to treat epilepsy
In some people, absence seizures continue even with medication.
Epilepsy surgery may be an effective option if:
- At least two different medications have not been effective at controlling seizures.
- Medication side effects are not tolerable.
- Your seizures are severe.
UPMC neurosurgeons offer a range of surgical options for people with absence seizures, including:
Neuromodulation device implantation
Implantation of a neuromodulatory device that sends electrical impulses to regulate or disrupt abnormal electrical signals and reduce seizures.
Procedures include:
- Vagus nerve stimulation (VNS) — Implantation of a device in the chest that delivers electrical pulses to your vagus nerve in the neck in an effort to prevent or disrupt seizures.
- Deep brain stimulation (DBS) — Implantation of electrodes in the brain to directly deliver electrical impulses that can reduce seizure activity.
- Responsive neurostimulation (RNS®) — Implantation of a device within the skull and electrodes within the brain that can detect seizure activity and respond with electrical stimulation to disrupt seizures.
Why Choose UPMC for Absence Seizure Care?
When you choose UPMC for absence seizure care, you will receive:
- Multidisciplinary care — Our team of epileptologists and neurosurgeons can work together to develop a customized epilepsy treatment plan that helps you manage seizures and minimize treatment side effects for medication-resistant epilepsy.
- Access to advanced clinical trials — Our team participates in national, multicenter clinical trials evaluating new epilepsy treatments, giving you the opportunity to contribute to research that advances seizure disorder care.
- Expert neurosurgery care — People with medication-resistant epilepsy can access leading-edge, minimally invasive neurosurgery treatment options that reduce seizures and restore quality of life.
