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Randomized Controlled Trial
. 2017 Aug 15;89(7):673-679.
doi: 10.1212/WNL.0000000000004226. Epub 2017 Jul 19.

Pretreatment Seizure Semiology in Childhood Absence Epilepsy

Free PMC article
Randomized Controlled Trial

Pretreatment Seizure Semiology in Childhood Absence Epilepsy

Sudha Kilaru Kessler et al. Neurology. .
Free PMC article


Objective: To determine seizure semiology in children with newly diagnosed childhood absence epilepsy and to evaluate associations with short-term treatment outcomes.

Methods: For participants enrolled in a multicenter, randomized, double-blind, comparative-effectiveness trial, semiologic features of pretreatment seizures were analyzed as predictors of treatment outcome at the week 16 to 20 visit.

Results: Video of 1,932 electrographic absence seizures from 416 participants was evaluated. Median seizure duration was 10.2 seconds; median time between electrographic seizure onset and clinical manifestation onset was 1.5 seconds. For individual seizures and by participant, the most common semiology features were pause/stare (seizure 95.5%, participant 99.3%), motor automatisms (60.6%, 86.1%), and eye involvement (54.9%, 76.5%). The interrater agreement for motor automatisms and eye involvement was good (72%-84%). Variability of semiology features between seizures even within participants was high. Clustering analyses revealed 4 patterns (involving the presence/absence of eye involvement and motor automatisms superimposed on the nearly ubiquitous pause/stare). Most participants experienced more than one seizure cluster pattern. No individual semiologic feature was individually predictive of short-term outcome. Seizure freedom was half as likely in participants with one or more seizure having the pattern of eye involvement without motor automatisms than in participants without this pattern.

Conclusions: Almost all absence seizures are characterized by a pause in activity or staring, but rarely is this the only feature. Semiologic features tend to cluster, resulting in identifiable absence seizure subtypes with significant intraparticipant seizure phenomenologic heterogeneity. One seizure subtype, pause/stare and eye involvement but no motor automatisms, is specifically associated with a worse treatment outcome.


Figure 1
Figure 1. Flow diagram for semiology cohort participants and seizures assessed
CAE = childhood absence epilepsy; n = number of participants; n′ = number of seizures.
Figure 2
Figure 2. Cluster plot of semiology features
Figure 3
Figure 3. Seizure cluster pattern combinations experienced by individual participants

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