Absence epilepsy
Brief 'blank' staring spells with a characteristic EEG — usually well controlled, with childhood absence epilepsy carrying a good outlook.
Absence epilepsy causes brief episodes of impaired awareness — sudden, short 'blank' staring spells, sometimes with eyelid flutter, that start and stop abruptly and may happen many times a day. Childhood absence epilepsy typically begins between ages 4 and 10 in otherwise healthy children and shows a characteristic 3-Hz spike-and-wave pattern on EEG. Most children respond well to treatment, and many outgrow it.
At a glance
- What it is
- Brief staring spells with sudden onset/offset
- Childhood onset
- Typically ages 4–10
- EEG
- Generalized 3-Hz spike-and-wave
- First-line
- Ethosuximide (absence only), or valproate
- Outlook
- Good in childhood absence epilepsy; most remit
What it is
Absence seizures are brief lapses of awareness lasting a few seconds, during which a child pauses, stares and is unresponsive, then resumes as if nothing happened — often with no memory of the episode. They can occur dozens of times a day and are sometimes mistaken for daydreaming or inattention. Childhood absence epilepsy is the most common form; a juvenile form begins around adolescence.
Diagnosis
Diagnosis is clinical and confirmed on EEG, which shows the typical generalized 3-Hz spike-and-wave discharges, often triggered by hyperventilation during the recording. Brain imaging is usually normal and not always required in classic childhood absence epilepsy.
Treatment
Ethosuximide is the preferred first choice when absence seizures occur alone, as it is at least as effective as valproate with fewer effects on attention; valproate is used when generalized tonic–clonic seizures also occur, and lamotrigine is an alternative. Importantly, some medicines — carbamazepine, oxcarbazepine, phenytoin, vigabatrin and gabapentin — can worsen absence seizures and are avoided.
Prognosis
Childhood absence epilepsy generally has a good outlook, and most children eventually grow out of it. The juvenile form is more likely to need longer-term treatment. Recognising and treating frequent absences matters because they can interfere with learning and safety.
How an educational review can help
An educational review can confirm the seizure type, explain the EEG, and clarify treatment choices (including which medicines to avoid) and the likely outlook — helping you prepare questions for your treating team. It is educational and does not replace your clinician's care.
Selected sources
- Glauser TA, et al. Comparative effectiveness of ethosuximide, valproic acid and lamotrigine in childhood absence epilepsy (NEJM).
- ILAE classification of childhood and juvenile absence epilepsy.
Last reviewed: 2026-05-22
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