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Childhood absence epilepsy (CAE)

BrainThis is a common epilepsy syndrome starting in early childhood. These seizures can happen in many different epilepsy syndromes occurring in childhood and adolescence. This information refers specifically to the syndrome of childhood absence epilepsy.

Symptoms

The seizures of childhood absence epilepsy usually start between the ages of four to nine years of age, and happen slightly more often in girls than boys. They can also happen many times a day, from 20 up to several hundreds.

A typical absence seizure consists of a sudden loss of awareness. The child will suddenly stop their activities and stare blankly into space. They will be unresponsive to voice. The seizure is sometimes associated with repetitive, purposeless movements of the mouth or eyes (called automatisms). This can include eyelid flickering or fluttering and lip smacking.

A seizure usually last between five and 20 seconds and usually stops as suddenly as it starts, with the child resuming their normal activities.

Absence seizures tend to happen more commonly when the child is bored, sitting quietly or when they are tired or unwell. Conversely, they happen less often when the child is engaged with an activity that they enjoy.

Children with CAE usually develop normally, although uncontrolled absence seizures may impact on the child’s ability to learn at school. Sometimes a child’s concentration or memory is said to be very poor before the diagnosis of the childhood absence epilepsy is made.

Diagnosis

The diagnosis is usually suggested by the history. The doctor may ask the child to hyperventilate (over-breathe) for three to four minutes while counting out loud. This will trigger an absence seizure in over 90 per cent of children with typical CAE, and is important in making the diagnosis.

An electroencephalogram (EEG) test is useful in confirming the diagnosis. The EEG may also be used to monitor response to treatment. No other tests such as a brain scan are required in typical CAE.

Treatment

CAE usually responds very well to treatment. The drugs of choice are sodium valproate (Epilim), ethosuximide (Zarontin) and lamotrigine (Lamictal). Occasionally a combination of two of these medications may be required to control absences.

Prognosis (Outlook)

The outlook of typical CAE is excellent, with the majority of children becoming seizure free as they pass through puberty.

About 70 per cent of children with CAE will have their absence seizures completely controlled with one or two antiepileptic drugs.

Approximately 10 per cent of children will develop other seizure types in adolescence, usually generalised tonic-clonic seizures. However these seizures are infrequent and tend to respond to treatment.

Some children with CAE may also develop other seizure types such as myoclonic seizures (sudden, brief jerks). When looked at in more detail these children will almost certainly not have CAE but instead have a different epilepsy syndrome such as juvenile absence epilepsy or juvenile myoclonic epilepsy.

Support organisation

Contact a Family
209-211 City Road
London EC1V 1JN
Phone: 0808 808 3555
Website: www.cafamily.org.uk

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 Our thanks

Epilepsy Action would like to thank:
• Dr Richard Appleton, and Dr Rachel Kneen, consultant paediatric neurologists at Alder Hey Children’s Hospital, Liverpool, UK and
• Dr Stewart Macleod, consultant paediatric neurologist at Royal Hospital for Sick Children, Glasgow, UK.
They have kindly prepared the information on this page. It is based on their own research, experience and expertise.

This information is exempt under the terms of The Information Standard.

  • Updated March 2012
    To be reviewed March 2015

Comments: read the 13 comments or add yours

Comments

I had petit mal as a,child and my 4 year old grandson has unfortunately developed it too. He is on a gradual increase of sodium volporate but the absences are still occurring at the moment. He seems to be very tired and irritable and his concentration levels are often quite poor, could this be a side effect of his medication and if so will it improve in time? His dose is 10mls morning and night currently.

Submitted by lesley marsh on

Dear Lesley

Your grandson’s tiredness, irritability and low concentrations levels may be related to his sodium valproate.

There is more risk that your grandson will get side-effects in the early days of taking his sodium valproate. Once his body has had a few days or weeks to get used to his sodium valproate,  these side-effects should lessen or disappear completely. If they don’t, talk to his family doctor or epilepsy specialist. They may be able to make changes to his sodium valproate to lessen the side-effects. Or if needed, they may change him to a different epilepsy medicine. Here’s a link to our information on anti-epileptic drug treatment.

Once your grandson reaches the right dose of the right epilepsy medicine for his size and bodyweight, there is a very good change the absences will stop.

I hope things settle down for your grandson.

Regards

Diane Wallace

Advice and Information Team

Submitted by Diane on

I have just found out that my son has juvenile absence epilepsy. Please do you have any information on this as the information on your sight is on Childhood absence epilepsy, thanks jo

Submitted by Jo on

Hi Jo

We are just producing a new webpage and factsheet on Juvenile Absence epilepsy. If you either email or phone the Epilepsy Helpline freephone 0808 800 5050, I will send you a draft copy of this information.

Yours sincerely

Diane

Submitted by Diane on

Hi. I was diagnosed with petit mal as a small child and had out grown it by age 5. I am now 56 and have only recently realised that I have really clear memories of this period of my life ( stronger memories than as an older child when I had outgrown this condition). I thought nothing of this until talking with friends who really don't remember anything before 4 or 5 years of age. Could it be that for some reason the brain was more active than normal? Has there been any research in this area? Just thought it was interesting.......

Submitted by Gail Prentice on

Hi Gail

That’s an intriguing piece of information.

There is a lot of research about different types of memory loss and epilepsy. But I don’t know of anything about particularly strong early memories.

Do please let us know if you come across anything.

Cherry

Advice and Information Team

Submitted by Cherry on

My 13 almost 14yr daughter has had an ongoing period where she has little absences. Often these happen when she is swimming - she is a competitive swimmer and trains 12h per week. She sometime mentions that she can't remember things - I can't remember coming home from school, I can't remember doing the number work, I can't remember how many metres I swam tonight. She has had an EEG which was shown clear so absence epilepsy was discounted. She is often confused after these absence episodes. She has also fallen down for no reason when doing an activity. As she is so sporty she has a low heart rate 50-55 typically. She has worn a 24h and also a 48h heart monitor to check this. A link between cardiology and the absences has also been discounted. They think her low heart rate is fine and normal for her.
Does the EEG always show when absence epilepsy is present?
Many thanks, Hazel

Submitted by Hazel on

Hi Hazel

Absences have a specific EEG type which can be triggered by hyperventilating during an EEG. But this doesn’t trigger other seizure types, which you may be confusing with absences. It might be a good idea to request a second opinion from an epilepsy specialist.

Sacha
Advice and Information Team

Submitted by Sacha on

My younger brother has just recently been diagnosed with epilepsy, the specialist isn't exactly sure which type of epilepsy, he is 13 nearly 14, he has been having absence type seizures since he was about 3 or 4 but that was misdiagnosed with ADD.. It wasn't until he had quite a big seizure at the end of last year that we really thought about the possibility of epilepsy and he got an EEG which really didn't show much except when he was sleeping , he had plenty of absence type seizures during the day but the majority of his seizures were actually at night, now that he has been diagnosed and being treated he is doing really well which is always good

Submitted by Cloe on

Hello! My 9 year old daughter was diagnosed with absence epilepsy on 3 April 2014. She is currently taking Epilum CR 300 twice a day, as well as 5mg Sibelium once a day to prevent migraines. She is on quite an emotional rollercoaster - can this be linked to the meds, or the epilepsy? She also losses her appetite very often - can thiS be linked to the meds? She was a very healthy eater, prefering healthy food to candy and crisps. Thanks for the information on the website. The onformation here has been so much more helpful than the epilepsy page for South Africa!

Submitted by Sam on

Hi Sam

We aren’t medically trained and couldn’t comment specifically about your daughter. The medicines, as well as epilepsy, could be contributing to how your daughter is feeling. Epilim (generic name sodium valproate) has many possible side effects, some which could be associated with what you have described. Sibelium (flunarizine) is not widely available in the UK. It might also be a factor. And, it may be that her body is still adjusting to the medicines. It would be best to consult with her doctor for specific advice. It could be that with an adjustment to her medicines she could start feeling better.

Sacha

Advice & Information Team

Submitted by Sacha-Epilepsy ... on

Good evening,
I find your website very useful, thank you very much for all your hard work.
I have a question please.
I suffered from epilepsy from the age of 5 (brought on (I've been told in the past by the death of my grandfather (I lived with my grandparents till the age of 8)) through to 12. Unfortunately, I have no way of finding out the details of any medications I might have been on as all my childhood medical history was destroyed by the Medical Practice I currently attend during their move to new premises. I am now 39, with two teenage children. I come to my question - I would like to know if there is any chance of my epilepsy returning? Is there anything I can do in my lifestyle to prevent this? The reason I am asking is I have been experiencing increasing episodes of headaches, slight memory loss, increase in making mistakes, especially when writing, and other less obvious effects. Thank you very much for your time.
Kind regards,
Magdalena Cullen

Submitted by Magdalena Cullen on

Dear Magdalena

Thank you for your question.

It sounds like your new symptoms could be quite distressing and difficult to live with. I can’t answer your question fully as no one knows if their epilepsy will ever return. But we do hear from people who have gone many years between seizures.  As there are a number of medical conditions that can cause symptoms similar to epilepsy. If you haven’t already, it would be advisable to talk to your GP. If your doctor thinks it could be epilepsy, they should refer you to an epilepsy specialist for a diagnosis.  This would usually be to a neurologist. The ideal would be to someone with a specialist interest in epilepsy, as there are many different neurological conditions, and neurologists tend to specialise in different ones.

You may wish to keep a diary of your symptoms. This could be helpful to the doctors.

Many people find that taking care of their wellbeing can help them to have as few seizures as possible. This simply means taking some steps to looking after your body and mind. This usually involves having a healthy diet, getting quality sleep, being active, and including mindfulness techniques to manage stress. It may be that this approach could help you. We have more details in the wellbeing section of our website: https://www.epilepsy.org.uk/info/wellbeing

Regards

Diane Wallace

Advice and Information Team

Submitted by Diane-Epilepsy ... on