Childhood Absence Epilepsy

Description

Other Names

Petit mal epilepsy, generalized nonconvulsive epilepsy

Diagnosis Coding

ICD-10

G40.A, absence epileptic syndrome

Additional digits indicating more details of diagnosis are needed for billable coding. They can be found at ICD-10 for Absence Epileptic Syndrome.

Description

Childhood absence epilepsy (CAE) is a form of genetically determined, generalized epilepsy that is characterized by absence seizures and, in 10% of cases, generalized tonic-clonic seizures. CAE accounts for 10–15% of childhood epilepsy. Absence seizures start between 4–12 years of age, have a peak occurrence at 6–7 years, and occur many times a day.

Absence seizures may also occur in juvenile absence epilepsy (JAE) and in juvenile myoclonic epilepsy (JME). In JAE, absence seizures start after age 10 and are the most common seizure type, but they often have a shorter duration and occur less frequently than those seen in CAE. Most patients with JAE develop generalized tonic clonic seizures. In JME, absence seizures are infrequent; the predominant seizure type is myoclonic seizures of the upper extremities on awakening, but generalized tonic clonic seizures occur as well.

Although absence seizures can occur in typical children, children with CAE have higher rates of behavioral, social, and educational problems, and a third of the children with CAE present with attention deficit. [Glauser: 2010] Behavioral problems and inattentiveness may be due to ongoing absence related to the amount of time with abnormal brain activity due to seizures or to the side effects of medication. Unless a child has a period of unresponsiveness that might be dangerous (e.g., while swimming or bathing), seizures do not cause death.

Prevalence

Prevalence is 1:3,571. [Posner: 2008]

Genetics

The etiology of CAE is genetic with complex multifactorial inheritance. Monozygotic twins have a 75% concordance rate and 15–45% of children with CAE have a positive family history. Affected family members may have other forms of idiopathic or generalized epilepsy, such as febrile convulsions and generalized tonic-clonic seizures. Absence epilepsy is linked to the GABA receptor gamma 2 subunit and the voltage-gated calcium channel alpha 1A subunit. [Weber: 2008] Absence seizures that start in children younger than 4 years of age are associated with a glucose transporter defect caused by a mutation in the SLC2A1 Gene (ILAE).

Prognosis

Remission during adolescence occurs in 65-70% of children with CAE. Good prognostic signs are earlier age at onset and absences as the only seizure type (no generalized tonic clonic seizures). [Wirrell: 1996] [Verrotti: 2011] Recurrence risk after antiepileptic treatment withdrawal in children who have been seizure free for 2 years is 16%. [Ramos-Lizana: 2010]

Roles Of The Medical Home

The medical home provider should recognize the clinical presentation of absence seizures, initiate diagnostic evaluation (EEG), and manage the seizures, which may involve prescribing medications. Initial care includes screening for attention disorders and evaluating educational achievement. Mood disorders can be comorbid with CAE, and anticonvulsants have been associated with suicidal thoughts and behavior; regular follow-up in the medical home is necessary to monitor for these complications. Refer to a pediatric neurologist when considering tapering medication; an EEG prior to that visit is helpful.

Other complications of on-going absence seizures include poor academic performance and injuries. If an absence seizure occurs while a child is swimming or taking a bath, drowning is possible. A child may not stop at curbs and walk into traffic if an absence seizure occurs. Review safety at every medical home visit, especially if seizures are not fully controlled with anticonvulsants. Complications of anticonvulsants are specific to each medication.

Practice Guidelines

No practice guidelines are available.

Helpful Articles

PubMed search for absence epilepsy in children, last 2 years.

Wheless JW, Clarke DF, Carpenter D.
Treatment of pediatric epilepsy: expert opinion, 2005.
J Child Neurol. 2005;20 Suppl 1:S1-56; quiz S59-60. PubMed abstract

Sidhu R, Velayudam K, Barnes G.
Pediatric seizures.
Pediatr Rev. 2013;34(8):333-41; 342. PubMed abstract

Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kälviäinen R, Mattson R, French JA, Perucca E, Tomson T.
Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes.
Epilepsia. 2013;54(3):551-63. PubMed abstract

Mula M, Kanner AM, Schmitz B, Schachter S.
Antiepileptic drugs and suicidality: an expert consensus statement from the Task Force on Therapeutic Strategies of the ILAE Commission on Neuropsychobiology.
Epilepsia. 2013;54(1):199-203. PubMed abstract

Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Adamson PC.
Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months.
Epilepsia. 2013;54(1):141-55. PubMed abstract / Full Text

Gaillard WD, Chiron C, Helen Cross J, Simon Harvey A, Kuzniecky R, Hertz-Pannier L, Gilbert Vezina L.
Guidelines for imaging infants and children with recent-onset epilepsy.
Epilepsia. 2009;. PubMed abstract

Caraballo RH, Dalla Bernardina B.
Idiopathic generalized epilepsies.
Handb Clin Neurol. 2013;111:579-89. PubMed abstract

Clinical Assessment

Screening

Of Family Members

Although no formal screening is recommended, families should be instructed to observe siblings for the presence of similar events.

For Complications

Screen for attention and mood disorders in all children with epilepsy, including CAE. Consider screening periodically for learning disorders since they commonly co-occur with CAE. See Screening Tools for Mood Disorders (Massachusetts General Hospital).

Presentations

Characteristics of absence seizures:
  • The child stares, sometimes blinks, eyes may begin to roll back.
  • Last 2–20 seconds, but usually about 10 seconds
  • Abruptly interrupts activity (such as drinking from cup or speaking)
  • The child isn't aware of his or her surroundings (e.g., not responsive to being called by name).
  • The child experiences many a day, sometimes up to 100.
  • The child has no warning, seizures begin and end suddenly.
  • Often evoked by hyperventilation - this is a good provocative test in the clinic

Diagnostic Criteria

Criteria is available at Childhood Absence Epilepsy (ILAE).

Inclusion Criteria:
  1. Age at onset is between 4-12 years, with a peak at 5-6 years
  2. Normal neurologic state and development
  3. Absence seizures are brief (4-20 seconds, rarely longer) and frequent (tens per day) with abrupt and severe impairment (loss) of consciousness. Automatisms are frequent, but have no significance in the diagnosis.
  4. An EEG shows 3 Hz spike and wave, or polyspike and wave, discharges during a clinical absence seizure. The EEG background is normal; interictal brief generalized spike and wave discharges can be seen, especially during sleep.
Exclusion criteria:
  1. Seizures other than typical absence seizures, such as generalized tonic-clonic seizures or myoclonic jerks
  2. Eyelid myoclonia, perioral myoclonia, rhythmic massive limb jerking, and single or arrhythmic myoclonic jerks of the head, trunk, or limbs. However, mild myoclonic elements of the eyes, eyebrows, and eyelids may be featured, particularly in the first 3 seconds of the absence seizure.
  3. Mild or no impairment of consciousness during the 3- to 4-Hz discharges
  4. Visual (photic) and other sensory precipitation of clinical seizures
Many children who almost meet these criteria, or who meet these criteria but have one of the exclusion criteria, are treated in the same way as those meeting the criteria, but they have a more guarded prognosis for being seizure free. [Valentin: 2007]

Differential Diagnosis

It can be difficult to differentiate between absence seizures, daydreaming, focal seizures, and attention disorders, but common characteristics of each may help. Daydreaming has no clear start or stop, can be interrupted, has varying durations, occurs less frequently than absence seizures, and occurs in predictable situations (e.g., the classroom). Focal seizures will often end with the child feeling confused and these usually occur infrequently (a few times a week, or a day, compared to many a day). Focal seizures are often longer than 20 seconds and m ay be accompanied by automatisms (lip smacking, teeth grinding, finger movements). Attention deficit disorder does not have discrete episodes of inattentiveness.

Absence seizures presenting in children less than 4 years old may be due to glucose transporter deficiency. The child should be referred to a neurologist or medical geneticist for further diagnostic testing. Treatment for seizures, including absence seizures, due to glucose transporter deficiency is the ketogenic diet. [ILAE: 2015]

Atypical absence seizures may be seen in children with developmental delays or intellectual disability. An EEG would show 1.5–2.5 Hz sharp-slow complexes. Atypical absence seizures are characterized by loss of consciousness, similar to an absence seizure but with more gradual onset and resolution, and they can have more motor abnormalities, such as brief body stiffening or jerking.

Comorbid Conditions

Children with absence epilepsy are at increased risk for learning and attention problems, depression, anxiety, and other mood disorders. [Cerminara: 2013] [Tenney: 2013]

Pearls & Alerts

Daydreaming vs. absence seizures

Since a diagnosis of absence epilepsy generally results in 2 years of treatment with an antiepileptic medication, it is important to have the correct diagnosis. Families and teachers of children with absence epilepsy almost always note an interruption of activity during the events, and children with absence epilepsy don't usually respond to the triad of touch, voice, and eye contact when someone tries to stop the seizure.

Children who don't respond to the medication

Refer to a pediatric neurologist to determine if the child has a different epilepsy syndrome and needs changes in treatment.

Signals for increasing medication

Declining school performance may signal a need for increased medication in a child already being treated for absence seizures.

History & Examination

Family History

Family history should be vigorously explored; it would not be surprising to find a history of seizures that went away by the teen years when the family inquires of other family members.

Pregnancy Or Perinatal History

Usually normal

Current & Past Medical History

Usually normal, there may be comorbid attention disorders, anxiety, or depression that pre-date recognition of absence seizures.

Developmental & Educational Progress

Inquire about school performance and whether the spells have been noted at school. Since absence seizures may occur hundreds of times a day, it is not uncommon for development, particularly in speech and language, or educational achievement, to be mildly impaired. Medications may also cause difficulty concentrating. After the child has been diagnosed, developmental and educational progress should be monitored closely.

Social & Family Functioning

Evaluate for mood disorders, which are more prevalent in children with seizures.

Physical Exam

General

The physical exam is usually normal in children with absence epilepsy. Hyperventilation for 2–3 minutes almost always induces an absence seizure.

Testing

Laboratory Testing

If the child is to be started on valproic acid or ethosuximide, include liver function tests (LFTs) and complete blood count (CBC) with differential to establish baseline levels for later comparison.

Imaging

In a child with typical absence epilepsy (characteristic EEG, clinical history, and normal development and exam), neuro-imaging is not usually necessary. [Gaillard: 2009]

Other Testing

EEG shows typical (frontally predominant) 3-Hz spike and wave complexes that occur in trains with hyperventilation and have an abrupt beginning and ending. Background activity is normal in children with CAE. After the child has been seizure free on medication for 2 years, an EEG may guide decisions about tapering medication.

Subspecialist Collaborations & Other Resources

Pediatric Neurology (see Services below for relevant providers)

Depending on the comfort of the medical home provider and family, a referral may be helpful to confirm the diagnosis, suggest management, and guide decisions about tapering medicine.

Electroencephalography (EEG) (see Services below for relevant providers)

A characteristic EEG is part of the diagnostic criteria for CAE.

Treatment & Management

Overview

Depending on factors, such as distance from the subspecialist and comfort of the medical home provider, management of the child with absence seizures who is typically developing and has a normal neurologic exam may be accomplished in the medical home. After the patient has been seizure free for 2 years, an optional consultation with a pediatric neurologist may be helpful when a medication taper is being considered.

How should common problems be managed differently in children with Childhood Absence Epilepsy?

Growth Or Weight Gain

Weight gain is a common side effect of valproate and ethosuximide. Active weight management may be necessary to prevent obesity.

Development (cognitive, motor, language, social-emotional)

Children with CAE should be expected to have typical development. Any delays or concerns should be assessed promptly.

Viral Infections

Infections can lower the seizure threshold. Families and patients should be vigilant for increased absence seizures during viral or bacterial infections. If needed, anticonvulsant dosing can be transiently increased, but most infections are short enough that this is not necessary.

Over The Counter Medications

Most over-the-counter medications do not interact with anticonvulsants used for CAE. Families should check with their pharmacist if there is any concern.

Prescription Medications

All prescription medications should be reviewed for possible interactions with anticonvulsants.

Common Complaints

Children with seizures, including absence seizures, often worry about being different than their peers, or about the possibility of dying. The medical home provider can provide reassurance to the child that their medical problems are being managed and that they are "normal." Siblings also wonder or worry about these issues. Local chapters of national organizations, such as the Childhood Absence Epilepsy (Epilepsy Foundation), often provide support groups or other resources for children and families.

Other

For all children taking anticonvulsants, calcium intake and vitamin D levels should be kept in the normal range to maintain optimal bone health. See Calcium and Vitamin D.

Pearls & Alerts

Ethosuximide does not prevent generalized tonic-clonic seizures and carbamazepine and gabapentin may make absence seizures worse.

If the child with absence seizures also has generalized tonic-clonic seizures, consider valproate or lamotrigine instead of ethosuximide.

Systems

Neurology

Most children with absence seizures who are developing normally and have a normal physical exam can be managed by their medical home without neurologic consultation. When the diagnosis is unclear, there are other findings that suggest alternate diagnoses or syndromes, or when the seizures fail to respond to standard therapy, consultation with a pediatric neurologist may be warranted. After a patient on treatment has been seizure free for 2 years, consultation with a pediatric neurologist may be useful if there are questions about a medication taper strategy.

Subspecialist Collaborations & Other Resources

Pediatric Neurology (see Services below for relevant providers)

Refer for help managing seizures that have had an onset younger than 4 years old, are occurring in the setting of developmental delay or intellectual disability, or are atypical.

Pharmacy & Medications

Three anticonvulsants have been well-studied in CAE: ethosuximide, valproate, and lamotrigine. Ethosuximide and valproate have the highest efficacy (~45% seizure free at 1 year), but of the two, valproate has significantly more side effects. Lamotrigine has lower efficacy (~20% seizure free at 1 year), but also low side effects. At onset of absence seizures, ethosuximide is a reasonable first choice. [Glauser: 2013]

Specific medications:
Ethosuximide (Zarontin): Start at approximately 10 mg/kg/day, divided twice daily (BID), and increase weekly to a dose approximately 30 mg/kg depending on response. Ethosuximide is hepatically metabolized, and the dose should be adjusted if there is hepatic dysfunction. There are case reports of agranulocytosis and fatal pancytopenia associated with ethosuximide. Check LFTs and CBC with differential before starting, and periodically thereafter. Ethosuximide comes as 250 mg capsules and as a 250mg/5ml syrup.

Valproic acid (Depakote): Start approximately 10 mg/kg/day, divided BID, and increase weekly to approximately 30 mg/kg depending on response. Valproate has been associated with fatal pancreatitis and hepatic failure. The incidence of valproate-induced hepatic failure in children less than 2 years old taking multiple anticonvulsants is 1/500-800. The risk is lower in older children and adults who are on valproate monotherapy. The risk of hepatic failure is greatest in the first 6 months of use. Valproate is a known teratogen and should be avoided in girls and women of childbearing age, if possible. Check LFTs and CBC before starting, and periodically thereafter. Many providers obtain a trough level, and repeat labs every 3–6 months until the patient is stabilized. Valproic acid comes in liquid, sprinkles, and capsules, and in regular and extended release forms.

Lamotrigine (Lamictal): Increase dose slowly due to the risk of severe skin reactions (Stevens Johnson syndrome). If the child is already taking valproic acid, the starting dose is lower and the titration is slower. Adding lamotrigine to valproate, and vice versa, should be done only with the recommendation of a pediatric neurologist. When used by itself, lamotrigine is started at approximately 0.3 mg/kg/day, and increased every 1–2 weeks to about 50–400 mg/day. It comes in chewable and dispersible tablets.

Tapering medications:
A seizure-free interval of 1-2 years is recommended before tapering medication. Some clinicians choose to do an EEG, then taper if it is normal or keep the child on medication for another year if abnormal.

Subspecialist Collaborations & Other Resources

Pediatric Genetics (see Services below for relevant providers)

Refer for help in evaluating and perhaps managing absence seizures with onset younger than 4 years old (associated with glucose transport defect secondary to a genetic mutation).

Pediatric Neurology (see Services below for relevant providers)

Refer for help managing absence seizures that are refractory to ethosuximide, have had onset younger than 4 years old, occur in the setting of developmental delay or intellectual disability, or are atypical.

Learning/Education/Schools

Children with CAE may have educational difficulties for many reasons including:
  • Neurocognitive defects [Kernan: 2012]
  • Loss of learning time due to frequent seizures before treatment
  • Poor seizure control even with treatment
  • Side effects of medication
  • Mood disorders
Children should be monitored closely. The medical home provider can request testing results and IEPs from the school; input regarding progress and IEP goals may be helpful for the child and school. A description of attention and executive function in 15 children with absence epilepsy compared to age-matched controls can be found in [D'Agati: 2012].

Subspecialist Collaborations & Other Resources

Early Intervention Programs (see Services below for relevant providers)

Refer babies and toddlers with developmental delays or disabilities.

Frequently Asked Questions

Can primary care providers diagnose absence seizures?

Yes. When the history is suggestive of absence seizures (e.g., a 5-year-old with 10-second spells of inattentiveness), the provider can have the child hyperventilate in clinic for 2–3 minutes. Having the child blow on a paper towel is a common maneuver. If hyperventilation induces a behavioral arrest lasting about 10 seconds, with an abrupt onset and abrupt offset, then they child almost certainly has absence seizures. This kind of seizure is brief and safe to evoke in clinic. An EEG will confirm diagnosis.

What should I do if the child has an absence seizure?

If you elicit an absence seizure in clinic with hyperventilation, educate the parents about the diagnosis and prognosis. You can start ethosuximide as described above.

What are the consequences of not treating childhood absence seizures?

Without treatment, children can have hundreds of absence seizures a day. This can significantly impair their ability to learn and participate in school and family life. Absence seizures can also interrupt normal motor activity. For instance, if a child has an absence seizure while walking on a sidewalk, he or she might not stop at the curb and instead walk into traffic.

Issues Related to Childhood Absence Epilepsy

Nutrition/Growth/Bone

Calcium and Vitamin D

Resources

Information for Clinicians

International League Against Epilepsy
Up-to-date diagnostic criteria, genetics, testing, and differential diagnosis of absence seizures and childhood absence epilepsy.

Genetics in Primary Care Institute (AAP)
The goal of this site is to increase collaboration in the care of children with known or suspected genetic disorders. Includes health supervision guidelines and other useful resources; a collaboration among the Health Resources & Services Administration, the Maternal and Child Health Bureau, and the American Academy of Pediatrics.

Childhood Absence Epilepsy (OMIM)
Extensive literature review organized by description, clinical features, genetics, diagnosis, differential diagnosis, management, nomenclature, history, and animal models; Online Mendelian Inheritance in Man.

Helpful Articles

PubMed search for absence epilepsy in children, last 2 years.

Caraballo RH, Dalla Bernardina B.
Idiopathic generalized epilepsies.
Handb Clin Neurol. 2013;111:579-89. PubMed abstract

Gaillard WD, Chiron C, Helen Cross J, Simon Harvey A, Kuzniecky R, Hertz-Pannier L, Gilbert Vezina L.
Guidelines for imaging infants and children with recent-onset epilepsy.
Epilepsia. 2009;. PubMed abstract

Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kälviäinen R, Mattson R, French JA, Perucca E, Tomson T.
Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes.
Epilepsia. 2013;54(3):551-63. PubMed abstract

Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Adamson PC.
Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months.
Epilepsia. 2013;54(1):141-55. PubMed abstract / Full Text

Mula M, Kanner AM, Schmitz B, Schachter S.
Antiepileptic drugs and suicidality: an expert consensus statement from the Task Force on Therapeutic Strategies of the ILAE Commission on Neuropsychobiology.
Epilepsia. 2013;54(1):199-203. PubMed abstract

Sidhu R, Velayudam K, Barnes G.
Pediatric seizures.
Pediatr Rev. 2013;34(8):333-41; 342. PubMed abstract

Wheless JW, Clarke DF, Carpenter D.
Treatment of pediatric epilepsy: expert opinion, 2005.
J Child Neurol. 2005;20 Suppl 1:S1-56; quiz S59-60. PubMed abstract

Clinical Tools

Patient Education & Instructions

Let's Talk about...EEG (Intermountain Healthcare) (PDF Document 107 KB)
Fact sheet about electroencephalographs that measure brain activity.

Other

Screening Tools for Mood Disorders (Massachusetts General Hospital)
For each screening tool, a table indicates age range, number of items, completion time, and whether it can be viewed online for free.

Information & Support for Families

Family Diagnosis Page

Information on the Web

Childhood Absence Epilepsy (Epilepsy Foundation)
National organization with local chapters that provides information and support.

Absence Seizure (Mayo Clinic)
Information about tests, treatments, coping, complications, and support for absence seizures.

Support National & Local

Epilepsy Association of Utah
Provides services to individuals who deal with the challenges of epilepsy and seizure disorders.

Services for Patients & Families

Early Intervention Programs

See all Early Intervention Programs services providers (52) in our database.

Electroencephalography (EEG)

See all Electroencephalography (EEG) services providers (1) in our database.

Health Insurance, Other

See all Health Insurance, Other services providers (64) in our database.

Pediatric Genetics

See all Pediatric Genetics services providers (5) in our database.

Pediatric Neurology

See all Pediatric Neurology services providers (10) in our database.

For other services related to this condition, browse our Services categories or search our database.

Authors

Author: Lynne M Kerr, MD, PhD - 6/2013
Reviewing Author: Denise Morita, MD - 12/2015
Content Last Updated: 12/2015

Bibliography

Caraballo RH, Dalla Bernardina B.
Idiopathic generalized epilepsies.
Handb Clin Neurol. 2013;111:579-89. PubMed abstract

Cerminara C, D'Agati E, Casarelli L, Kaunzinger I, Lange KW, Pitzianti M, Parisi P, Tucha O, Curatolo P.
Attention impairment in childhood absence epilepsy: an impulsivity problem?.
Epilepsy Behav. 2013;27(2):337-41. PubMed abstract

D'Agati E, Cerminara C, Casarelli L, Pitzianti M, Curatolo P.
Attention and executive functions profile in childhood absence epilepsy.
Brain Dev. 2012;34(10):812-7. PubMed abstract

Gaillard WD, Chiron C, Helen Cross J, Simon Harvey A, Kuzniecky R, Hertz-Pannier L, Gilbert Vezina L.
Guidelines for imaging infants and children with recent-onset epilepsy.
Epilepsia. 2009;. PubMed abstract

Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kälviäinen R, Mattson R, French JA, Perucca E, Tomson T.
Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes.
Epilepsia. 2013;54(3):551-63. PubMed abstract

Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Adamson PC.
Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months.
Epilepsia. 2013;54(1):141-55. PubMed abstract / Full Text

Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Capparelli EV, Adamson PC.
Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy.
N Engl J Med. 2010;362(9):790-9. PubMed abstract / Full Text

ILAE.
Metabolic Epilepsies.
International League Against Epilepsies; (2015) https://www.epilepsydiagnosis.org/aetiology/metabolic-epilepsies-overv.... Accessed on 12/16/2015.

Kernan CL, Asarnow R, Siddarth P, Gurbani S, Lanphier EK, Sankar R, Caplan R.
Neurocognitive profiles in children with epilepsy.
Epilepsia. 2012;53(12):2156-63. PubMed abstract

Mula M, Kanner AM, Schmitz B, Schachter S.
Antiepileptic drugs and suicidality: an expert consensus statement from the Task Force on Therapeutic Strategies of the ILAE Commission on Neuropsychobiology.
Epilepsia. 2013;54(1):199-203. PubMed abstract

Posner E.
Absence seizures in children.
BMJ Clin Evid. 2008;2008. PubMed abstract / Full Text

Ramos-Lizana J, Aguirre-Rodríguez J, Aguilera-López P, Cassinello-García E.
Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: a prospective study.
Eur J Paediatr Neurol. 2010;14(2):116-24. PubMed abstract

Sidhu R, Velayudam K, Barnes G.
Pediatric seizures.
Pediatr Rev. 2013;34(8):333-41; 342. PubMed abstract

Tenney JR, Glauser TA.
The current state of absence epilepsy: can we have your attention?.
Epilepsy Curr. 2013;13(3):135-40. PubMed abstract / Full Text

Valentin A, Hindocha N, Osei-Lah A, Fisniku L, McCormick D, Asherson P, Moran N, Makoff A, Nashef L.
Idiopathic generalized epilepsy with absences: syndrome classification.
Epilepsia. 2007;48(11):2187-90. PubMed abstract

Verrotti A, Olivieri C, Agostinelli S, Coppola G, Parisi P, Grosso S, Spalice A, Zamponi N, Franzoni E, Iannetti P, Chiarelli F, Curatolo P.
Long term outcome in children affected by absence epilepsy with onset before the age of three years.
Epilepsy Behav. 2011;20(2):366-9. PubMed abstract

Weber YG, Lerche H.
Genetic mechanisms in idiopathic epilepsies.
Dev Med Child Neurol. 2008;50(9):648-54. PubMed abstract

Wheless JW, Clarke DF, Carpenter D.
Treatment of pediatric epilepsy: expert opinion, 2005.
J Child Neurol. 2005;20 Suppl 1:S1-56; quiz S59-60. PubMed abstract

Wirrell EC, Camfield CS, Camfield PR, Gordon KE, Dooley JM.
Long-term prognosis of typical childhood absence epilepsy: remission or progression to juvenile myoclonic epilepsy.
Neurology. 1996;47(4):912-8. PubMed abstract