Therapy of Petit Mal (Absence) Seizures
Gregory L. Holmes MD1
1 Assistant Professor of Pediatrics and Neurology, University of Connecticut Health Center, Farmington, and Newington Children's Hospital, Newington, Connecticu
Although petit mal or typical absence seizures are not life threatening, it is important for the pediatrician to recognize the disorder because untreated they can affect school performance, increase the risk of accidental injury, and lead to the victim's being ridiculed by classmates for being "spacey."
CLASSIFICATION
Unfortunately, petit mal is probably the most misused term in epileptology. In 1969, The International League Against Epilepsy published a classification of epileptic seizures entitled The International Classification of Epilepsy. This classification, which has recently undergone revision, categorizes seizures into two groups: partial, seizures in which the first clinical and electroencephalographic changes indicate initial activation of a system of neurons limited to a part of one cerebral hemisphere, and generalized, those in which the first clinical changes indicate initial involvement of both hemispheres. In absence seizures, as in all primary generalized seizures, the ictal EEG patterns are bilateral and reflect neuronal discharge which is widespread. Absence seizures can be further subdivided into typical and atypical absences (Table 1).
Although the term petit mal has been eliminated from the revised International Classification of Seizures, the term is still widely used by physicians. Most physicians use it to describe a simple absence with impairment of consciousness only, and with a rhythmic, three cycles per second, spike and wave discharge on the electroencephalogram in a child between age 3 years and puberty who has normal intelligence and in whom a neurologic examination prduces normal findings.
