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