Spotting absence seizures

BENGALURU : Aditi, a class 4 student was good at studies. She could grasp things quickly and remember them. Her teachers and parents were happy with her progress. However, as the mode of education became virtual, her teacher observed that Aditi would sometimes stare blankly at the screen before returning to normal. Her teacher attributed this change in behaviour to the teaching method going from offline to online. Soon, her mother also noticed that Aditi was not paying attention to the class and staring blankly at the wall or screen. 

Although, Aditi would become normal within a few seconds, her parents noted that she could not recall some of the lessons from school and look confused when asked about certain things. Thinking that Aditi is daydreaming and losing interest in studies, her parents decided to consult a paediatrician. After speaking to Aditi and the parents, the paediatrician was concerned that Aditi’s symptoms suggested more than daydreaming, but were in fact suggestive of absence seizures. An EEG was requested which confirmed the diagnosis and Aditi was commenced on the right medication. 

Absence seizures are sudden episodes of a short blank out which often affects children between the age of 4 to 14. Kids suffering from absence seizure may stare at blank space and return to a normal level of alertness within few seconds. In most cases absence seizure is mistaken with day-dreaming or lack of attention and there is a high chance of ignoring the symptoms. In some kids, absence seizure may take months or years to get recognised. 

Children suffering from absence seizure may show lapse in attention for 10-20 seconds. However, once they become normal, they do not remember the incident.  A few children may face many seizure episodes on a daily basis which may not get recognised. This will affect the learning and daily activities of kids. 

Causes of absence seizure
These types of seizures are caused by abnormal electrical impulses from nerve cells in the brain. In many cases, it occurs due to the genetic predisposition. Differentiating between absence seizures and daydreamingAbsence seizures occur suddenly, whereas a child daydreams when s/he is bored. Unlike daydreaming, these absence seizures cannot be interrupted. Episode of absence seizures end on their own in about 10-20 seconds. Daydreaming usually goes till the child is interrupted like the teacher or his friends noticing him and calls for his attention. In an absence seizure, the child stares blankly and stops talking in the middle of speech. The eyes may also turn upwards and eyelids could flutter.

Many children grow out of absence seizures by the time they reach puberty whilst some may need to continue with anti-seizure medication for longer periods whist a small number may go on to develop a full-blown generalised tonic clonic convulsion. A paediatrician along with a neurologist will need to follow up closely and alter the treatment as needed. Correct diagnosis is crucial as absence seizures are often mistaken with other types of seizures. A specialist might suggest an electroencephalogram (EEG) as it is one of the safe and painless ways to diagnose absence seizures. (The author is a consultant, Paediatrics and Paediatric Endocrinology, Columbia Asia Hospital Whitefield - a unit of Manipal Hospitals)

Symptoms of absence seizure

•  Appearing motionless
• Staring blankly at walls or other objects
•  Lip smacking
•  Fluttering eyelids
• Abruptly stopping a conversation 
• Sudden hand movements