Staring-Spell Seizures: They're Not All the Same

Most people understand that there are multiple types of epileptic seizures. The best known variety--and certainly the most spectacular--is often termed "grand mal," which is French for "major illness." In these attacks the patients lose consciousness, fall to the ground and experience convulsive jerking of their bodies that lasts for 1-2 minutes before subsiding. These attacks are more properly termed tonic-clonic seizures. A less dramatic form of epilepsy also involves loss of consciousness, but without a fall to the ground or convulsive movements. These attacks are aptly called "staring spells" because the patients stop what they're doing, lose eye-contact with other people, and appear to stare into space. If spoken to during attacks, the patients do not respond. What is often under-appreciated is that more than one kind of epileptic attack can take the form of a staring spell. And the differences between them can be crucial in understanding the underlying causes as well as the best treatments. Staring-spell seizures are often lumped together in public awareness under the heading of "petit mal" epilepsy. Petit mal is French for "minor illness," reflecting their more subtle appearance. However, using current terminology, there are two main kinds of staring-spell attacks--absence seizures and partial-complex seizures. Absence attacks correspond to the original "petit mal" designation, while partial-complex seizures were once called "psychomotor seizures" and "temporal lobe epilepsy." The "temporal lobe" label reflects the fact that most seizures of this kind emanate from one of the two temporal lobes, the portions of the brain nearest the tops of the ears. Although both absence and partial-complex seizures involve staring and unresponsiveness, that's where the similarities end. The attacks differ in the following ways: * usual ages of onset * duration * symptoms recalled by the patients * movements or behaviors during the attacks * after-effects * electroencephalogram (EEG) patterns * underlying causes * most effective treatments Absence seizures begin in childhood, and often in the pre-school years. They usually disappear by the time the individuals who have them reach their twenties. Partial complex seizures can begin in either childhood or adulthood, including late in life. So if a middle-aged person has staring-spell seizures, they are almost always of the partial-complex type. The duration of the attacks also separates the two kinds of seizures. Absence seizures are shorter. Most of them end within 10 seconds, and they almost never continue for 30 seconds. In contrast, partial-complex seizures are longer than 30 seconds, and typically last 2-3 minutes. Most children with absence seizures are unaware of having them, though might notice a loss of time. The relative lack of symptoms in absence seizures, along with their brevity, can cause them to be overlooked. Teachers, noticing episodic loss of eye-contact, are often the first to detect them. But children and adults experiencing partial-complex seizures often recognize them due to specific, recurrent--and often complex--symptoms. One person with partial-complex seizures might notice a sudden, particular odor that no one else can smell. Another patient might experience a sudden sense of familiarity with their surroundings, a perception that they had been there before (also known as "d