THE DIFFERENT TYPES OF EPILEPTIC SEIZURE: TYPICAL ABSENCES

(PETIT MAL SEIZURES)

Although a translation of petit mal is the ‘little illness’, petit mal does not mean the same as ‘minor epilepsy’ as there are all sorts of small attacks which are not attacks of petit mal. True petit mal seizures, or typical absences are, by definition, associated with a characteristic EEG discharge. Short-lived partial seizures arising from a focus of abnormal nerve cells in one temporal lobe of the brain may be somewhat similar on clinical grounds, but the distinction is worth making because of the difference in cause, treatment, and outcome between the two.

Absence epilepsy is virtually invariably a disorder of childhood. A typical attack is very brief, lasting only a few seconds. The onset and termination are abrupt. The child will suddenly cease what she is doing, stare, look a little pale, perhaps flutter her eyelids, and drop her head slightly forwards. Posture of the limbs and trunk is usually maintained so she does not fall. After the seizure, the child resumes what she has been doing. Because the interruption of the normal stream of consciousness is so brief, attacks may be unobserved by parents, and not remarked upon by the affected children. One of us has seen a typical attack in a supermarket. A girl aged about nine was helping her mother unload a wire basket at the checkout. She suddenly paused, with a pot of honey held in the air between basket and counter, fluttered her eyelids, and then continued transferring the purchase without further pause.

Whereas one would be unfortunate to have more then one grand mal seizure in a day, absence seizures may be very frequent—10 to 50 seizures a day being occasionally encountered. Fortunately most children have far fewer attacks.

Absence seizures are often associated with myoclonic jerks, which are particularly frequent soon after waking. These are brief shock-like contractions of the muscles, which are so

short-lived it is not really possible to tell whether consciousness is disturbed or not. We have heard this described by one family as ‘the flying saucer syndrome’ in reference to the broken crockery that may occur as a result of jerks at breakfast-time!

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