A petit mal seizure is the term commonly given to a staring spell, most commonly called an "absence seizure." It is a brief (usually less than 15 seconds) disturbance of brain function due to abnormal electrical activity in the brain.

See also:

• Generalized tonic-clonic seizure
• Partial (focal) seizure
• Seizures

Petit mal seizures occur most commonly in people under age 20, usually in children ages 6 to 12. They can occur as the only type of seizure but can also happen along with other types of seizures such as generalized tonic-clonic seizures (also called grand mal seizures), twitches or jerks (myoclonus), or sudden loss of muscle strength (atonic seizures).

In many cases, no cause is found for typical petit mal seizures. Atypical petit mal seizures may or may not be associated with other neurological disorders.

Sometimes, family history may play a role in certain types of seizures.

Most petit mal seizures last only a few seconds. Most commonly they involve staring episodes or "absence spells."

The person may stop walking or talking in mid-sentence, and start again a few seconds later. The person usually does not fall. The person is usually wide awake and thinking clearly immediately after the seizure.

"Spells" can be uncommon or occur up to hundreds of of times in one day. They may occur for weeks to months before they are noticed, and may interfere with school function and learning. The seizures may sometimes be mistaken for a lack of attention or other misbehavior. Unexplained difficulties in school and learning difficulties may be the first indication of petit mal seizures.

Symptoms of typical petit mal seizures may include:

• Muscle activity changes
  • No movement
  • Hand fumbling (especially with longer spells)
  • Fluttering eyelids
  • Lip smacking (especially with longer spells)
  • Chewing (especially with longer spells)
• Consciousness changes
  • Staring episodes (unintentional)
  • Lack of awareness of surroundings
  • Sudden halt in conscious activity (movement, talking, etc.)
  • May be provoked by hyperventilation or flashing lights, in some cases
  • Abrupt beginning of seizure
  • Each seizure lasts no more than a few seconds
  • Full recovery of consciousness, no confusion
• No memory of seizure

Atypical petit mal seizures begin slower, last longer, and may have more noticeable muscle activity than typical petit mal seizures. There is usually no memory of the seizure. Symptoms may include:

• Unintentional staring
• Lack of awareness of surroundings
• Sudden stop of conscious activity (movement, talking, etc.)
• Hand fumbling
• Fluttering eyelids
• May be provoked by hyperventilation, in some cases
• May have slower, gradual beginning of seizure
• Each lasts only seconds to minutes
• Recovery may be slower
• May have short period of confusion or bizarre behavior
• No memory of seizure
• May change into a different type of seizure (such as a grand mal or atonic seizure)

A doctor will diagnose this type of seizure based on the symptoms and after ruling out other medical conditions that can cause similar symptoms. Disorders that may cause symptoms resembling seizures include transient ischemic attacks, rage, or panic attacks.

A neuromuscular examination done when the person is not actively having seizures may or may not reveal any problems.

An EEG may show changes and possible the location of the cause of the seizure. This test can be normal in between seizures. A normal EEG does not rule out a seizure disorder.

Blood tests may be done to determine the cause of the seizures. This may include:

• Blood chemistry
• Blood sugar (glucose)
• Complete blood count
• Kidney function tests (BUN, creatinine, and others)
• Liver function tests
• Tests for infectious diseases

• Head CT or MRI scan
• Lumbar puncture (spinal tap)

Unlike in other seizure types, a CT or MRI scan may not be needed if the child a petit mal seizure is completely typical in a child.

Seizures can interfere with learning or result in injury. The goal of treatment is to prevent or reduce the number of seizures and to minimize any side effects of the treatments.

In some cases, avoiding loss of sleep, stress or anxiety, and alcohol or drugs, may reduce or eliminate seizures.

Anticonvulsant (antiseizure) medications may prevent or minimize the number of seizures. Medicines used to treat petit mal seizures include:

• Valproic acid
• Ethosuximide
• Clonazepam

This list is not all-inclusive.

Everybody responds differently to medication. The health care provider may need to adjust the drug dosage every now and then until the right one is found.

Depending on the drug prescribed, frequent blood tests may be done to determine if the medicine is working properly and to make sure it isn't causing any unseen side effects.

Persons with multiple, frequently-repeated seizures may need to receive medicines through a vein (IV), and other treatments.

Epilepsy Foundation of America -- www.epilepsyfoundation.org

Most people with petit mal seizures live a fairly normal life, with few restrictions on school activities or social life. As adulthood approaches, restrictions may be placed on driving or operating dangerous machinery if seizures continue.

Nearly all children with petit mal seizures have significantly fewer (or no) seizures when treated with the proper medications.

Petit mal seizures may go away on their own after the child reaches adulthood, they may continue indefinitely, or the person may stop having absence spells but continue having other type of seizures..

Adults with absence seizures often have more trouble controlling them with medications. They commonly have other types of seizures along with the absence spells.

A person's long-term outlook depends on whether there are any underlying neurological problems or if they also have other seizure types.

• Injury from falls, bumps, and biting oneself
• Injury to oneself or others if seizure occurs during driving or operating machinery
• Inhaling fluid into the lungs, pneumonia
• Learning disorders
• Permanent brain damage
• Prolonged or closely occurring seizures without returning to normal behavior (status epilepticus)
• Medication side effects
• Seizure disorder

Women who are pregnant or planning to become pregnant may need to take additional medications or vitamins, such as folic acid supplements, to reduce the risk of birth defects associated with certain antiseizures drugs. Such women may need to be followed in a high-risk pregnancy clinic.

Certain antiseizure drugs may cause or worsen osteoporosis. People taking these medicines for a long period of time should discuss their risk of osteoporosis with their doctor.

Call your local emergency number (such as 911) if this the first time a person has had a seizure or a seizure is occurring in someone who is not wearing a medical ID bracelet and does not carry instructions explaining what to do in the event of a seizure.

If the person has had a seizure before, call for an ambulance if:

• The seizure lasts longer than unusual
• The person is having an unusual number of seizures
• Repeated seizures occur over a few minutes
• Repeated seizures occur and the person does not wake up (regain consciousness) or act normally between each one

Call the health care provider if a person with seizures has new symptoms, inluding:

• Confusion
• Extreme sleepiness
• Drowsiness
• Hair loss
• Nausea or vomiting
• Problems with coordination
• Rash
• Restlessness
• Tremors or abnormal movements

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Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69(21):1991-2007.

Pollack CV Jr. Seizures. In: Marx, JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, PA: Mosby Elsevier; 2006: chap 100.

Spenser SS. Seizures and Epilepsy. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders Elsevier; 2007: chap 426.

Tomson T, Hiilesmaa V. Epilepsy in pregnancy. BMJ. 2007 Oct 13;335(7623):769-73.