Absence Seizures, also known as Black out Siezures


These are the most misdiagnost form of Epilepsy.  In most cases, Epilepsy of any form is looked for via CT/Cat scans, but Absence Seizures, also known as Black out Sieszures, are not of the brain they are of they heart.  They are capable of effectively duplicating the same symptoms of nearly all other forms of Epilesy, but…

Although manifestations of their seizures are usually subtle, children with absence seizures need prompt and effective treatment because their seizures can interfere with learning. They also interfere with attention and full consciousness.  

What to Do:

No immediate first aid is usually necessary, but a medical evaluation is indicated to try to prevent these seizures from recurring. If this is the first observation of an absence seizure, medical evaluation is recommended. Absence seizures (e.g. a seizure common to petit mal epilepsy) are lapses of awareness, sometimes with staring, that begin and end abruptly, lasting only a few seconds. There is no warning and no after-effect.

More common in children than in adults, absence seizures almost always start between ages 4 and 12 years, and rarely do they begin after age 20. Absence seizures are characterized by a brief impairment of consciousness, which usually lasts no more than a few seconds. The child, whether sitting or standing, simply stares vacantly; neither speaking nor apparently hearing what is said. Then, as abruptly as it began, the impairment lifts and the child continues with his or her previous activity. The seizure is usually associated with some degree of altered awareness . Automatisms may occur in prolonged absence seizures. Absence seizures are frequently so brief that they escape detection, even if the child is experiencing 50 to 100 episodes daily. They may occur for several months or even years before a child is sent for a medical evaluation.

Absence Seizure Characteristics:

  • No aura
  • Abrupt onset
  • Brief duration
  • Prompt recovery

Some absence seizures are accompanied by brief myoclonic jerking of the eyelids or facial muscles, or by variable loss of muscle tone. More prolonged episodes may be accompanied by automatisms, which may lead them to be confused with complex partial seizures. However, complex partial seizures last longer, may begin with an aura and are usually marked by some type of confusion following the seizure.

Absence seizures may occur only occasionally or more than 100 times a day. Most children with typical absence seizures are otherwise normal.  About half the children also have infrequent generalized tonic-clonic seizures. The electroencephalographic (EEG) pattern of diffuse spike-wave is closely correlated with absence seizures.

EEG showing generalized 3Hz (this means within a one-second period there are approximately three epilepsy waves) spike and wave discharges in a patient having an absence seizure.

Absence seizures are often confused with complex partial seizures. This is an important distinction because the drugs that prevent absence seizures have little or no effect on complex partial seizures. Conversely, the most effective drugs for complex partial seizures are either ineffective against or increase the frequency of absence seizures.

 

What is syncope? 
Syncope is temporary loss of consciousness and posture, described as “fainting” or “passing out.” It’s usually related to temporary insufficient blood flow to the brain. It most often occurs when the blood pressure is too low(hypotension) and the heart doesn’t pump a normal supply of oxygen to the brain.

What causes syncope?
It may be caused by emotional stress, pain, pooling of blood in the legs due to sudden changes in body position, overheating, dehydration, heavy sweating or exhaustion. Syncope may occur during violent coughing spells (especially in men) because of rapid changes in blood pressure. It also may result from several heart, neurologic, psychiatric, metabolic and lung disorders. And it may be a side effect of some medicines.

Some forms of syncope suggest a serious disorder:

  • those occurring with exercise 
  • those associated with palpitations or irregularities of the heart 
  • those associated with family history of recurrent syncope or sudden death

What is neurally mediated syncope?
Neurally mediated syncope (NMS) is called also neurocardiogenic, vasovagal, vasodepressor or reflex mediated syncope. It’s a benign (and the most frequent) cause of fainting. However, life-threatening conditions may also manifest as syncope. NMS is more common in children and young adults, although it can occur at any age. NMS happens because blood pressure drops, reducing circulation to the brain and causing loss of consciousness. Typical NMS occurs while standing and is often preceded by a sensation of warmth, nausea, lightheadedness and visual “grayout.” If the syncope is prolonged, it can trigger a seizure. Placing the person in a reclining position will restore blood flow and consciousness and end the seizure.

 

AHA Recommendation

The majority of children and young adults with syncope have no structural heart disease or significantarrhythmia (abnormal heart rhythm). So, extensive medical work-up is rarely needed. A careful physical examination by a physician, including blood pressure and heart rate measured lying and standing, is generally the only evaluation required.

In other cases an electrocardiogram (EKG or ECG) is used to test for abnormal heart rhythms such aslong Q-T syndrome. This is a genetic heart condition that can cause sudden cardiac deathOther tests, such as exercise stress testHolter monitor, echocardiogram, etc., may be needed to rule out other cardiac causes of syncope.

If EKG and cardiac tests are normal, the person will undergo a tilt test. The blood pressure and heart rate will be measured while lying down on a board and after the board is tilted up. Someone who has NMS will usually faint during the tilt, due to the rapid drop in blood pressure and heart rate. As soon as the person is placed on his or her back again, blood flow and consciousness are restored.

To help prevent syncope, people with NMS should be on a higher-salt diet (this is recommended only for persons diagnosed with NMS) and drink plenty of fluids to avoid dehydration and maintain blood volume. They should watch for the warning signs of fainting — dizziness, nausea and sweaty palms — and sit or lie down if they feel the warning signs. Some people also may need medication.
 

 

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