Childhood absence usually begins in the first or second decade of life and is marked by multiple, brief episodes of staring (up to 100 times per day), without loss of body tone. Automatisms are sometimes seen. Childhood absence seizures often resolve by late adolescence, but they may persist into adulthood.

Occasionally, absence seizures develop in elderly patients with no prior history of seizures.17,18 Patients with this condition appear confused, are variably responsive, and may express automatisms. This state may persist for weeks or months before it is detected.19 It is easy to miss in the emergency department unless one is aware of its presentation. It is usually diagnosed in elderly individuals who are confused, sometimes with a low-grade fever and no other obvious cause of altered sensorium. Diagnosis of this type of absence seizure requires urgent, bedside electroencephalogram (EEG).

Absence seizures in seniors usually respond to low-dose IV benzodiazepines.20,21

Adapted from: Kolb SJ and Litt B. Management of epilepsy and comorbid disorders in the emergency room and intensive care unit. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;515–535. With permission from Elsevier (www.elsevier.com).

Authored By: 
Steven J. Kolb Md PhD
Brian Litt MD
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Reviewed By: 
Steven C. Schachter MD
on: 
Saturday, May 1, 2004