INFORMATION FOR CANDIDATE:

Your next patient in general practice is a 9 year

old boy, Troy. His step father comes with him
because Troy has had frequent episodes of
stopping all activity and staring at home and
school for about 2-3 months.
YOUR TASK IS TO:
Take a further history
Examine the boy
Explain the most likely diagnosis and
management to the step father

HOPC:
For about 2-3 months the family noticed that Troy often stops all his activities and just
stares into the air, not moving at all, attacks usually last for 5-10 seconds only and then he
is immediately back to his normal state. There is no shaking or fitting, no jerky
movements, no cyanosis, no incontinence, no post ictal episodes.
His school teacher observed the same behaviour and does not know what to think about it
but it definitely influences Troys performance at school.
PHx.: normal pregnancy, delivery and development until now, no febrile convulsions, no
illnesses, no operations, NKA.
FHx.: unremarkable
SHx: lives in a blended family with 1 younger step sister, whose mother actually died
couple of years ago. Troy had initially problems to relate to his step father and step sister
but things have settled quite well.
EXAMINATION:
General appearance normal, vital signs normal, neurological exam normal, all other
systems normal.
DIAGNOSIS: absence seizures (previously called petit mal)
Absence seizures (also called petit mal or generalized nonconvulsive seizures) are a
common paediatric genetic epileptic disorder. The seizures consist of multiple brief
staring episodes with behavioural arrest that may recur hundreds of times daily without
warnings. They are associated with generalized 3-hertz spike and slow wave discharges
on electroencephalogram (EEG). Sometimes there may be eyelid flickering or fluttering,
jerky movement of the face or fingers, lip-smacking or chewing (called complex
absences).
There are known variants for example epilepsy with myoclonic abscences (EMA) and the
Lennox-Gastaut syndrome (LGS) and myoclonic-astatic epilepsy (MAE) are more serious
epileptic disorders in which children always have other seizure types, including tonic and
atonic seizures, as well as developmental delay.
The prognosis for seizure remission differs for each syndrome. Childhood absence
epilepsy (typical absence seizures with occasional generalized tonic-clonic seizures and
an EEG pattern of generalized 3/sec spike and wave activity in a neurologically healthy
child) has a reasonably good long-term prognosis with disappearance of seizures in the
teen years.
Often attack can be evoked by hyperventilation.
INVESTIGATIONS:
EEG during an attack (can be evoked by hyperventilation or sleep deprivation)
MANAGEMENT:
1. Drug of choice- ethosuxamide (Zarontin)
2. Sodium valproate (!hepato toxicity!)
3. Clonazepam
4. Gabapentin