Treatment Of Absence Seizure Is Safe

Question: Our eight-year-old daughter was recently diagnosed to have “absence seizures” that last one to two seconds. Our doctor started her on Depakene and told us that she may outgrow the seizures in a few years. We are concerned about the side effects of this medicine, and the long term outlook of these seizures.

Answer:

Absence (or petit mal) seizure is a fairly common type of childhood seizure. Most children begin to have this seizure before puberty, but it is uncommon in children under 5 years of age. There are more girls affected by this seizure than boys, although the reason is still unclear.

The most characteristic feature of absence seizure is a sudden pause of motor activity. If the child is speaking when the seizure occurs, there will be a brief pause, and the child can continue to finish the sentence as if nothing has happened. During the seizure, the child can have a blank face, or appears to be staring into space. Sometimes there is flickering of the eyelids. More importantly, the child does not fall during absence seizure.

There is no warning before the onset of seizure, and most children are not aware that it has happened. In contrast to other more severe seizures, children with absence seizure do not get tired afterwards.

The frequency of absence seizure can be quite variable. Some children can have several seizures a day, while others can have thousands. If the seizures are infrequent, parents and teachers may not even recognize the problem. However, frequent absence seizure can affect a child’s school performance if he/she keep missing out important information.

Scientists have not been able to pinpoint the cause of absence seizures. The diagnosis, however, is relatively simple. The “staring spells” are characteristic, and they can be induced by asking the child to breathe deeply and continuously for 2 to four minutes. This can be confirmed by an electroencephalogram (EEG) or “brain-wave” test. Children with absence seizure have typical abnormal waves in the EEG.

Sodium valproate (also called Depakene) and a related medicine, divalproex sodium (Epival), are very effective in treating absence seizure as well as many other types of seizure. They are generally safe with few minor side effects like nausea, vomiting, indigestion, and increase appetite. Some children can be a little tired at the beginning.

There are two rare but serious side effects. The first one is a Reye syndrome like illness where the child becomes increasingly lethargic with vomiting, finally leading to coma if the medicine is continued. This condition can be reversed by stopping the medicine.

Rarely, sodium valproate has been associated with liver damage and death. In the few reported cases in North America, these affected children all had complicated brain problems and were on several convulsion medications at the same time. Therefore, it is advisable to do blood tests every few months to make sure that everything is normal.

In addition to Depakene, several newer medications are also effective for absence seizures.   However, it is best to discuss your concern about seizure medications directly with your physician.

Finally, not everyone will outgrow absence seizure. Research has actually shown that about one-third of these children will develop generalized seizures, with jerking of arms and legs, when they reach puberty. Fortunately, medications that are effective in treating absence seizures are usually effective for these more serious seizures.

[Note to Readers:  The information in this column is by and large current. Absence seizure has been renamed and grouped under partial complex seizure. Treatment is still the same, other seizure medications are also used and just as effective.]