Snapshot A 6-year-old boy is brought to the pediatrician by his parent’s due to episodes of “staring into space.” This occurs several times a day and lasts only a few seconds. During these episodes, the boy is unresponsive to the parents and does not fall down or shake. After the episode, the boy returns to his normal activity and is not confused. The parent’s deny any history of head trauma, medications, or infection. Neurological exam is normal. An EEG is performed, which shows 3-Hz spike and wave form. Introduction Generalized epilepsy syndrome in an otherwise healthy child leads to loss of conciousness without losing muscle tone no postictal confusion eletroencephalogram (EEG) shows 3-Hz spike waves can have many seizure episodes per day Precipitating factors include hyperventilation emotions (e.g., anger, fear) Epidemiology Most commonly seen in children ages 4 - 12 Family history is a likely risk factor Presentation Symptoms periods of impaired consciousness behavioral arrest, unresponsive after seizure event, patients return to activity short (~4 - 20 seconds long) may have automatisms, tonic-clonic, or myoclonus myoclonus may involve the eyelids Evaluation EEG 3-Hz spike and wave discharge Differential Juvenile myoclonic epilepsy recurrent spasms shortly after waking or when sleep-deprived Lennox-Gastaut syndrome Attention-deficit hyperactive disorder (ADHD) Day dreaming Treatment Medications ethosuximide first-line valproate also effective initial therapy may be first-line in concomitant generalized clonic-tonic seizures lamotrigine not as effective as ethosuximide or valproate Complications May have impairments in neuropsychological or cognitive development most are neurologically and intellectually fine Prognosis May be self-limiting however, there is variable seizure outcome