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Playing Hide and 'Seizure': Understanding Absent Seizures

Absence seizures are often overlooked because they can easily be mistaken for daydreaming or lack of attention. However, research suggests that absence seizures comprise about 10% of all seizures in children. Characterized by a brief, sudden lapse of consciousness, typically lasting only a few seconds, absence seizures can occur multiple times daily and might disrupt a student's learning process significantly. As frontline health personnel in schools, understanding absence seizures and implementing effective interventions can substantially enhance a school nurse's contribution to a healthy and conducive learning environment for all students. 

What is an absence seizure?

It is estimated that among all cases of epilepsy in school-aged children, 10% to 17% are due to childhood absence epilepsy (CAE), a type of epilepsy that causes absence seizures. Similar to other types of seizures, they result from abnormal electrical activity in the brain, and, in the case of absence seizures, the signal disruption causes a short-lived period of staring into space or "blanking out." Absence seizures are ​​classified as generalized onset seizures since they begin on both sides of the brain at the same time.

Once referred to as "petit mal" seizures, absence seizures most commonly affect children between ages 4 and 14. Frequent episodes are common, occurring anywhere from 10 to up to 100 times a day, often going unnoticed. While some may have a family history of similar seizures, there is no genetic connection or known cause for most children with CAE. Up to 70% of children with absence seizures cease having them by age 18. In very few cases, less than 10%, some children may also have infrequent generalized tonic-clonic seizures, but it is rare for them to continue experiencing absence seizures past adolescence. 

What are the symptoms?

There are two types of absence seizures, each exhibiting slightly different characteristics. During a "typical absence seizure," a student may suddenly pause and stare, their eyes may turn upwards, or experience fluttering of the eyelids. This type usually lasts 10-20 seconds, after which there may be a few seconds of confusion before the student returns to baseline. Alternatively, "atypical absence seizures" have a slower onset, last longer than 20 seconds, and involve a change in muscle tone or movements, including blinking rapidly, fidgeting with hands, or smacking lips.

Depending on the seizure duration, the student may or may not be aware of what has happened. If the seizure is brief, they may not even realize they had one. However, if the seizure lasts longer, they may know they have missed some time. If someone tries to speak to them during the seizure, they will not respond or acknowledge them. Even if the student is speaking when the seizure starts, the pause in speech may appear like a natural break to an observer. 

How can school nurses help?

After an absence seizure, students can mostly resume their prior activity without assistance. These seizures usually don't affect the student's level of alertness, and they remain fully awake and able to think clearly. In most cases, absence seizures don't require first aid or medical intervention, but reassurance may be needed, as well as provisions to ensure important information or directions aren't missed.

When it comes to accommodating students with absence seizures or any other form of epilepsy, their Section 504 Accommodation Plan or Individualized Education Program should outline the necessary measures to cater to their health, safety, and educational requirements. Maintaining an up-to-date seizure emergency action plan and any relevant medication orders on file is also essential.

Finally, school staff who come into contact with students with CAE should be provided education on seizure recognition, seizure first aid, and the potential impact of absence seizures on learning and psychosocial development. Working together for effective school-based seizure management, school nurses, teachers, parents, and healthcare providers can significantly improve a child's quality of life and ability to thrive academically and socially.

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