Absence seizure

Diagnosis

When evaluating your child’s seizures, the healthcare provider will probably ask for a detailed description of the episodes. They may also conduct a physical examination. Additionally, to gather more information, the following tests might be performed:

• Electroencephalography (EEG): This non-invasive procedure involves measuring the electrical activity in the brain by placing small metal plates, called electrodes, on the scalp using paste or an elastic cap. During an EEG, your child may be asked to engage in rapid breathing, known as hyperventilation, which can trigger absence seizures. The EEG machine records the brain waves, and any abnormalities in the pattern can indicate a seizure.
• Brain scans: Imaging techniques like MRI (Magnetic Resonance Imaging) can be utilized to eliminate other possible causes of the seizures, such as strokes or brain tumors. These scans provide detailed images of the brain, but they require the child to remain still for extended periods. If necessary, you can discuss with the healthcare provider the potential use of sedation to help your child remain calm during the procedure.

Treatment

The healthcare provider for your child may initially prescribe the lowest dosage of anti-seizure medication available. Depending on the effectiveness in controlling seizures, the provider may gradually increase the dosage as necessary. If the child remains seizure-free for a period of two years, under the supervision of the provider, there is a possibility of gradually reducing and discontinuing the anti-seizure medication.

The medications commonly prescribed for absence seizures are as follows:

• Ethosuximide: This is usually the initial drug of choice for treating absence seizures, and it often yields positive results. Potential side effects may include nausea, vomiting, sleepiness, sleep disturbances, and hyperactivity.
• Valproic acid: Valproic acid is effective for children who experience both absence seizures and tonic-clonic seizures (grand mal seizures). Side effects can include nausea, attention problems, increased appetite, and weight gain. In rare cases, it may lead to inflammation of the pancreas and liver failure. Females who require long-term medication into adulthood should have a discussion with their healthcare providers about the potential risks of valproic acid, as it has been associated with a higher risk of birth defects in babies. Typically, it is advised not to use this medication during pregnancy or when attempting to conceive.
• Lamotrigine: Lamotrigine has been found to have slightly lower efficacy compared to ethosuximide or valproic acid in certain studies. However, one of its notable advantages is that it tends to cause fewer side effects. Common side effects associated with lamotrigine include rash and nausea.

Although a ketogenic diet could be considered, there isn’t enough strong evidence to support its effectiveness. It might be an option to try if your child’s absence seizures don’t improve with medication.