A child presents with sho episodes of vacant stare several times a day. The vacant episode begins abruptly and the child remains unresponsive during the episode. There is no associated history of aura or postictal confusion and the child is otherwise normal. The likely diagnosis is

Answer is B (Absence seizures): Presence of multiple sho episodes of vacant stare (absence) in an otherwise normal child with no history of aura or postictal confusion suggests the diagnosis of typical absence seizures. Absence seizures versus Dav dreaming Absence seizures can easily be confused with episodes day dreaming however there are ceain clues that can help differentiate these two conditions Day dreaming is usually not associated with automatism while automatism is common in seizures. Day dreaming can often be 'broken' with stimulation while seizures can usually not be 'broken'. Day dreaming usually occurs when child is tired /bored or involved in a monotonous activity but seizures can sta abruptly at any time (for example in the middle of a sentence). Abrupt onset of vacant episodes and the fact that the child remains unresponsive during the episode (cannot be broken) ours a diagnosis of absence seizures in this child. Absence seizures versus complex paial seizures Complex paial seizures are frequently associated with aura and postictal confusion. Absence of these features ours a diagnosis of 'Absence seizures' Absence seizures must primarily be differentiated from complex paial seizures and Day dreaming Clinical data Absence Complex paial Daydreaming Frequency/day Multiple Rarely over 1-2 Mutiple; situation-dependent Duration Frequently < 10 sec (Rarely longer than 30 sec) Average duration ober 1 min, 10 sec Seconds to minutes; rarely more rarely less Aura Never Frequently' No Eye blinking Common Occasionally No Automatism Common Frequently No Postictal impairment None Frequently No Seizures activated by 1-11p er yen ti la tio n Very frequently Occassionallv No Photic Frequently Rarely No EEG ktul Generalized spike and wave Usually unilateral or bilateral temporal frontal discharges Normal Interictal Usually normal Variable; may be spikes or sharp waves in frontal or temporal lobes Normal