Childhood Absence Epilepsy

Overview

Childhood absence epilepsy (CAE) is a form of genetically determined, generalized epilepsy that is characterized by absence seizures and, in 10% of cases, generalized tonic-clonic seizures. In CAE, absence seizures start between 4–12 years of age, have a peak occurrence at 6–7 years, and occur many times a day. CAE accounts for 10–15% of childhood epilepsy.

Absence seizures may occur in other epileptic syndromes, such as juvenile absence epilepsy (JAE) and juvenile myoclonic epilepsy (JME). In JAE, absence seizures start after age 10 and are the most common seizure type, but they often have a shorter duration and occur less frequently than those seen in CAE. Most patients with JAE develop generalized tonic-clonic seizures. In JME, absence seizures are infrequent; the predominant seizure type is myoclonic seizures of the upper extremities on awakening, but generalized tonic-clonic seizures occur as well.

Children with CAE have higher rates of behavioral, social, and educational problems, and a third of the children with CAE present with attention deficit disorder. [Glauser: 2010] In addition to attention deficit disorder, inattentiveness may be due to ongoing absence seizures or to the side effects of antiepileptic drugs. Accidental injury is fairly common; yet, unless a child has a period of unresponsiveness during an activity that might be dangerous (e.g., while swimming or bathing), absence seizures do not cause death. [Tenney: 2013]

Other Names & Coding

Generalized nonconvulsive epilepsy
Petit mal epilepsy
ICD-10 coding

G40.A, Absence epileptic syndrome

Additional digits indicating the details of diagnosis are needed for billable coding. They can be found at ICD-10 for Absence Epileptic Syndrome.

Prevalence

Prevalence is 1:3,571. [Posner: 2008]

Genetics

The etiology of CAE is genetic with complex multifactorial inheritance. Monozygotic twins have a 75% concordance rate and 15–45% of children with CAE have a positive family history. Affected family members may have other forms of idiopathic or generalized epilepsy, such as febrile convulsions and generalized tonic-clonic seizures. Absence epilepsy is linked to the GABA receptor gamma 2 subunit and the voltage-gated calcium channel alpha 1A subunit. [Weber: 2008]

Prognosis

Remission during adolescence occurs in 65-70% of children with CAE. A lower chance of resolution may be indicated by the presence of generalized seizures, onset of seizures in children <4 years (some may have glucose transporter deficiency caused by a mutation in the SLC2A1 Gene (ILAE), children >8 years, and lack of response to initial therapy. [Tenney: 2013] Recurrence risk after antiepileptic treatment withdrawal in children who have been seizure free for 2 years is 16%. [Ramos-Lizana: 2010]

Practice Guidelines

No practice guidelines are available.

Roles of the Medical Home

The medical home provider should recognize the clinical presentation of absence seizures, initiate diagnostic evaluation (EEG), and manage the seizures, which may involve prescribing antiepileptic drugs. Additional initial care includes screening for attention disorders and evaluating educational achievement. Mood disorders can be comorbid with CAE, and antiepileptic drugs have been associated with suicidal thoughts and behavior. Mood should be assessed at medical home visits.

Children with seizures, including absence seizures, may worry about being different than their peers or even about the possibility of dying. The medical home provider can provide reassurance to the child that their medical problems are being managed and that they are "normal." Siblings also wonder or worry about these issues. Local chapters of national organizations, such as the Epilepsy Foundation, often provide support groups or other resources for children and families.

Complications of on-going absence seizures include poor academic performance and injuries. If an absence seizure occurs while a child is swimming or taking a bath, drowning is possible. A child may not stop at curbs and walk into traffic if an absence seizure occurs. Review safety at every medical home visit, especially if seizures are not fully controlled with antiepileptic drugs. Medication side effects are specific to each antiepileptic drug. Regular follow-up in the medical home is necessary to monitor for all of these comorbidities and complications.

Refer to a pediatric neurologist when considering tapering off an antiepileptic drug; an EEG prior to that visit can be helpful.

Clinical Assessment

Pearls & Alerts for Assessment

Daydreaming vs. absence seizures

Since a diagnosis of absence epilepsy generally results in 2 years of treatment with an antiepileptic drug, it is important to have the correct diagnosis. Families and teachers of children with absence epilepsy almost always note an interruption of child’s activity during the event. Children with absence epilepsy don't usually respond to the triad of touch, voice, and eye contact when someone tries to stop the seizure.

Uncontrolled seizures

If the child is not responding to the antiepileptic drug, refer to a pediatric neurologist to determine if the child has a different epilepsy syndrome and needs changes in treatment.

Signals for increasing medication

Declining school performance may signal a need for an increased antiepileptic drug dose in a child already being treated for absence seizures.

Screening

Of Family Members

Although no formal screening is recommended, families should be instructed to observe siblings for the presence of any kind of seizure.

For Complications

Screen for attention and mood disorders in all children with epilepsy, including CAE. Consider screening periodically for learning disorders since they commonly co-occur with CAE.

Presentations

Characteristics of absence seizures:
  • Staring, sometimes blinking, eyes may begin to roll back
  • Lasts 2–20 seconds, but usually about 10 seconds
  • Abruptly interrupts activity (such as drinking from a cup or speaking)
  • Unaware of his or her surroundings (e.g., not responsive to being called by name)
  • Many a day, sometimes up to 100
  • No warning - seizures begin and end suddenly
  • Often evoked by hyperventilation - this is a good provocative test in the clinic

Diagnostic Criteria

Criteria are available at Childhood Absence Epilepsy (ILAE).

Inclusion Criteria:
  1. Age at onset is between 4-12 years, with a peak at 6-7 years
  2. Normal neurologic state and development
  3. Absence seizures are brief (4-20 seconds, rarely longer) and frequent (tens per day) with abrupt and severe impairment (loss) of consciousness. Automatisms are frequent, but they have no significance in the diagnosis.
  4. An EEG shows 3 Hz spike and wave or polyspike and wave discharges during a clinical absence seizure. The EEG background is usually normal; interictal brief generalized spike and wave discharges can be seen, especially during sleep.
Exclusion criteria:
  1. Seizures other than typical absence seizures, such as generalized tonic-clonic seizures or myoclonic jerks
  2. Eyelid myoclonia, perioral myoclonia, rhythmic massive limb jerking, and single or arrhythmic myoclonic jerks of the head, trunk, or limbs; however, mild myoclonic elements of the eyes, eyebrows, and eyelids may be featured, particularly in the first 3 seconds of the absence seizure
  3. Mild or no impairment of consciousness during the interictal 3- to 4-Hz discharges
  4. Visual (photic) and other sensory precipitation of clinical seizures
Many children who almost meet these criteria or meet these criteria but have 1 of the exclusion criteria are treated in the same way as those meeting the criteria, but they have a more guarded prognosis for being seizure free. [Valentin: 2007]

Differential Diagnosis

It can be difficult to differentiate among absence seizures, daydreaming, focal seizures, and attention disorders, but understanding the common characteristics of each may help.

Daydreaming has no clear start or stop, can be interrupted, has varying durations, occurs less frequently than absence seizures, and occurs in predictable situations (e.g., the classroom).

Focal seizures usually infrequently occur (a few times a week, or a day, compared to many a day) and end with the child feeling confused. Focal seizures are often longer than 20 seconds and may be accompanied by automatisms (lip smacking, teeth grinding, finger movements). Attention deficit disorder does not have discrete episodes of inattentiveness.

Absence seizures presenting in children <4 years old may be due to glucose transporter deficiency. The child should be referred to a neurologist or medical geneticist for further diagnostic testing. The ketogenic diet is the treatment for seizures, including absence seizures, due to glucose transporter deficiency.

Atypical absence seizures may be seen in children with developmental delays or intellectual disability. Atypical absence seizures are characterized by loss of consciousness (similar to an absence seizure but with more gradual onset and resolution), and they can have more motor abnormalities, such as brief body stiffening or jerking. An EEG would show 1.5–2.5 Hz sharp-slow complexes.

Since absence seizures occur frequently, they are often diagnosed on a routine EEG. They also often can be elicited by hyperventilation. If investigating whether an event such as staring off or a brief alteration in consciousness is a seizure and a routine EEG is non-diagnostic, then a prolonged EEG in the hospital or at home may be considered. In these cases, the parents or other observers would have a pushbutton to record an event of concern when they see it, which then would allow the EEG reader to look for epileptiform activity during the identified time.

Comorbid & Secondary Conditions

Children with absence epilepsy are at increased risk for learning and attention problems, depression, anxiety, and other mood disorders. [Cerminara: 2013] [Tenney: 2013] For assessment information, see:

History & Examination

Current & Past Medical History

History is usually normal, but there may be comorbid attention disorders, anxiety, or depression that pre-date recognition of absence seizures.

Family History

Family history should be vigorously explored. It would not be surprising to find a history of seizures that resolved by adolescence when the family inquires of other family members.

Pregnancy/Perinatal History

Usually normal

Developmental & Educational Progress

Ask about school performance and whether the spells have been noted at school. Since absence seizures may occur hundreds of times a day, it is not uncommon for development (particularly in speech and language) or educational achievement to be mildly impaired. Antiepileptic drugs may also cause difficulty concentrating. After the child has been diagnosed, developmental and educational progress should be monitored closely.

Social & Family Functioning

Evaluate for mood disorders, which are more prevalent in children with seizures.

Physical Exam

General

The physical exam is usually normal in children with absence epilepsy. Hyperventilation for 2–3 minutes almost always induces an absence seizure.

Testing

Laboratory Testing

If the child is to be started on valproic acid or ethosuximide, include liver function tests (LFTs) and complete blood count (CBC) with differential to establish baseline levels for later comparison.

Imaging

In a child with typical absence epilepsy (characteristic EEG, clinical history, and normal development and exam), neuroimaging is usually not necessary. [Gaillard: 2009]

Other Testing

During an absence seizure, the EEG shows 3-Hz spike and wave discharges (often frontally dominant) that have an abrupt beginning and ending. Background activity is usually normal in children with CAE. After the child has been seizure free on an antiepileptic drug for 2 years, an EEG may guide decisions about tapering off the dose.

Specialty Collaborations & Other Services

Pediatric Neurology (see MT providers [15])

Depending on the comfort of the medical home provider and family, a referral may be helpful to confirm the diagnosis, suggest management, and guide decisions about tapering off an antiepileptic drug.

Electroencephalography (EEG) (see MT providers [0])

A characteristic EEG is part of the diagnostic criteria for CAE.

Treatment & Management

Overview

Most children with absence seizures who are typically developing and have a normal neurologic exam can be managed in the medical home. After the patient has been seizure free for 2 years, an optional consultation with a pediatric neurologist may be helpful when an antiepileptic drug taper is being considered.

Pearls & Alerts for Treatment & Management

Treating multiple seizure types

Ethosuximide does not prevent generalized tonic-clonic seizures. If a child with absence seizures also has generalized tonic-clonic seizures, consider valproate instead of ethosuximide. Lamotrigine is considered second-line therapy for absence seizures but may be helpful when there are other seizure types. [Kanner: 2018]

Drugs that may increase absence seizures

Carbamazepine and gabapentin may increase absence seizures.

How should common problems be managed differently in children with Childhood Absence Epilepsy?

Growth or Weight Gain

Weight gain is a common side effect of valproate and ethosuximide. Active weight management may be necessary to prevent obesity.

Development (cognitive, Motor, Language, Social-Emotional)

Children with CAE should be expected to have typical development. Any delays or concerns should be assessed promptly.

Viral Infections

Infections can lower the seizure threshold. Families and patients should be vigilant for increased absence seizures during viral or bacterial infections. If needed, antiepileptic drug dosing can be transiently increased, but most infections are short enough that this is not necessary.

Over the Counter Medications

Most over-the-counter medications do not interact with antiepileptic drugs used for CAE. Families should check with their pharmacist if there is any concern.

Prescription Medications

All prescription medications should be reviewed for possible interactions with antiepileptic drugs. For all children taking antiepileptic drugs, calcium intake and vitamin D levels should be kept in the normal range to maintain optimal bone health. See Calcium and Vitamin D.

Systems

Neurology

The medical home clinician can manage most children with absence seizures who are developing typically and have a normal physical exam without neurologic consultation. Consider consultation with a pediatric neurologist when the diagnosis is unclear, findings suggest alternate diagnoses or syndromes, or seizures fail to respond to standard therapy. After a patient has been seizure free for 2 years, consider consultation with a pediatric neurologist for questions about a strategy to taper off medications.

Specialty Collaborations & Other Services

Pediatric Neurology (see MT providers [15])

Refer for help diagnosing and managing absence seizures that began in children <4 years old, are occurring in the setting of developmental delay or intellectual disability, or are atypical.

Pharmacy & Medications

Three antiepileptic drugs have been well-studied in CAE: ethosuximide, valproate, and lamotrigine. Ethosuximide is only effective for absence seizures - not the generalized convulsive seizures sometimes associated with this diagnosis. Ethosuximide and valproate have the highest efficacy (~45% seizure free at 1 year) for absence seizures, but of the two, valproate has significantly more side effects. Lamotrigine has lower efficacy and is considered to be inferior to valproate (~20% seizure free at 1 year) but has low side effects. At onset of absence seizures, ethosuximide is a reasonable first choice. [Kanner: 2018] [Rosati: 2018] [Glauser: 2013]

Ethosuximide (Zarontin)
Childhood absence seizures are the only indication for ethosuximide. It is hepatically metabolized; the dose should be adjusted if there is hepatic dysfunction. There are case reports of agranulocytosis and fatal pancytopenia associated with ethosuximide. Check LFTs and CBC with differential before starting and periodically thereafter. Ethosuximide comes as 250 mg capsules and as a 250mg/5ml syrup.

Valproic acid (Depakote)
Valproate has been associated with fatal pancreatitis and hepatic failure. The incidence of valproate-induced hepatic failure in children <2 years old taking multiple anticonvulsants is 1:500 to 1:800. The risk is lower in older children and adults who are on valproate monotherapy. The risk of hepatic failure is greatest in the first 6 months of use. Valproate is a known teratogen and should be avoided in girls and women of childbearing age, if possible. Check LFTs and CBC with differential before starting and periodically thereafter. Many providers obtain a valproate trough level when the patient is stabilized and repeat labs every 3–6 months throughout treatment. Valproic acid comes in liquid, sprinkle capsules, and tablets (regular and extended release forms).

Lamotrigine (Lamictal)
Titrate the dose very slowly due to the risk of severe skin reactions (Stevens-Johnson syndrome). If the child is already taking valproic acid, the starting dose is lower and the titration is slower. Adding lamotrigine to valproate, and vice versa, should be done only with the recommendation of a pediatric neurologist. Lamotrigine comes in chewable, dispersible, and regular tablets.

Tapering antiepileptic drugs:
A seizure-free interval of 2 years is recommended before tapering off the antiepileptic drug. Some clinicians choose to do an EEG first. If it is normal, then consider tapering; if abnormal, then consider continuing antiepileptic drug therapy for another year.

Specialty Collaborations & Other Services

Pediatric Genetics (see MT providers [7])

Refer for help in diagnosing absence seizures with onset <4 years old, which can be due to a glucose transport deficiency secondary to a genetic mutation.

Pediatric Neurology (see MT providers [15])

Refer for help diagnosing absence seizures that started <4 years old and managing absence seizures that are refractory to ethosuximide, occur in the setting of developmental delay or intellectual disability, or are atypical.

Learning/Education/Schools

Children with CAE may have educational difficulties for many reasons including:
  • Neurocognitive defects [Kernan: 2012]
  • Loss of learning time due to frequent seizures before treatment
  • Poor seizure control even with treatment
  • Side effects of antiepileptic drugs
  • Mood disorders
Children with absence seizures should be monitored closely. The medical home provider can request testing results from the school and provide input for monitoring progress and IEP goals. A description of attention and executive function problems in 15 children with absence epilepsy compared to age-matched controls can be found in [D'Agati: 2012].

Specialty Collaborations & Other Services

Early Intervention for Children with Disabilities/Delays (see MT providers [24])

Refer babies and toddlers with developmental delays or disabilities.

Issues Related to Childhood Absence Epilepsy

Ask the Specialist

Can primary care providers diagnose absence seizures?

Yes. When the history is suggestive of absence seizures (e.g., a 5-year-old with 10-second spells of inattentiveness that have an abrupt onset and offset), the provider can have the child hyperventilate in clinic by having him or her blow on a paper towel for 2-3 minutes. If hyperventilation elicits a behavioral arrest lasting about 10 seconds with an abrupt onset and abrupt offset, then the child almost certainly has absence seizures. This kind of seizure is brief and safe to evoke in clinic. An EEG will confirm diagnosis.

What should I do if the child has an absence seizure?

If you elicit an absence seizure in clinic with hyperventilation, educate the parents about the diagnosis and prognosis. You can start ethosuximide as described above.

What are the consequences of not treating childhood absence seizures?

Without treatment, children can have hundreds of absence seizures a day, which can significantly impair learning and participation in school and family life. Absence seizures can also interrupt normal motor activity and cause injury. For instance, if a child has an absence seizure while walking on a sidewalk, he or she might not stop at the curb and instead step into traffic.

Resources for Clinicians

On the Web

International League Against Epilepsy
Up-to-date diagnostic criteria, genetics, testing, and differential diagnosis of absence seizures and childhood absence epilepsy.

Genetics in Primary Care Institute (AAP)
Contains health supervision guidelines and other useful resources for the care of children with genetic disorders; American Academy of Pediatrics.

Childhood Absence Epilepsy (OMIM)
Extensive literature review organized by description, clinical features, genetics, diagnosis, differential diagnosis, management, nomenclature, history, and animal models; Online Mendelian Inheritance in Man.

Helpful Articles

PubMed search for absence epilepsy in children, last 2 years.

Caraballo RH, Dalla Bernardina B.
Idiopathic generalized epilepsies.
Handb Clin Neurol. 2013;111:579-89. PubMed abstract

Gaillard WD, Chiron C, Helen Cross J, Simon Harvey A, Kuzniecky R, Hertz-Pannier L, Gilbert Vezina L.
Guidelines for imaging infants and children with recent-onset epilepsy.
Epilepsia. 2009. PubMed abstract

Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kälviäinen R, Mattson R, French JA, Perucca E, Tomson T.
Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes.
Epilepsia. 2013;54(3):551-63. PubMed abstract

Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Adamson PC.
Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months.
Epilepsia. 2013;54(1):141-55. PubMed abstract / Full Text

Mula M, Kanner AM, Schmitz B, Schachter S.
Antiepileptic drugs and suicidality: an expert consensus statement from the Task Force on Therapeutic Strategies of the ILAE Commission on Neuropsychobiology.
Epilepsia. 2013;54(1):199-203. PubMed abstract

Sidhu R, Velayudam K, Barnes G.
Pediatric seizures.
Pediatr Rev. 2013;34(8):333-41; 342. PubMed abstract

Wheless JW, Clarke DF, Carpenter D.
Treatment of pediatric epilepsy: expert opinion, 2005.
J Child Neurol. 2005;20 Suppl 1:S1-56; quiz S59-60. PubMed abstract

Clinical Tools

Patient Education & Instructions

Let's Talk about...EEG (Intermountain Healthcare) (PDF Document 107 KB)
Fact sheet about electroencephalographs that measure brain activity.

Resources for Patients & Families

Information on the Web

Childhood Absence Epilepsy (Epilepsy Foundation)
National organization with local chapters that provides information and support.

Absence Seizure (Mayo Clinic)
Information about tests, treatments, coping, complications, and support for absence seizures.

National & Local Support

Services for Patients & Families in Montana (MT)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Initial publication: June 2013; last update/revision: April 2019
Current Authors and Reviewers:
Author: Lynne M. Kerr, MD, PhD
Reviewer: Denise Morita, MD
Authoring history
2015: update: Denise Morita, MDR
2013: first version: Lynne M. Kerr, MD, PhDA
AAuthor; CAContributing Author; SASenior Author; RReviewer

Bibliography

Caraballo RH, Dalla Bernardina B.
Idiopathic generalized epilepsies.
Handb Clin Neurol. 2013;111:579-89. PubMed abstract

Cerminara C, D'Agati E, Casarelli L, Kaunzinger I, Lange KW, Pitzianti M, Parisi P, Tucha O, Curatolo P.
Attention impairment in childhood absence epilepsy: an impulsivity problem?.
Epilepsy Behav. 2013;27(2):337-41. PubMed abstract

D'Agati E, Cerminara C, Casarelli L, Pitzianti M, Curatolo P.
Attention and executive functions profile in childhood absence epilepsy.
Brain Dev. 2012;34(10):812-7. PubMed abstract

Gaillard WD, Chiron C, Helen Cross J, Simon Harvey A, Kuzniecky R, Hertz-Pannier L, Gilbert Vezina L.
Guidelines for imaging infants and children with recent-onset epilepsy.
Epilepsia. 2009. PubMed abstract

Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kälviäinen R, Mattson R, French JA, Perucca E, Tomson T.
Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes.
Epilepsia. 2013;54(3):551-63. PubMed abstract

Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Adamson PC.
Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months.
Epilepsia. 2013;54(1):141-55. PubMed abstract / Full Text

Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Capparelli EV, Adamson PC.
Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy.
N Engl J Med. 2010;362(9):790-9. PubMed abstract / Full Text

Kanner AM, Ashman E, Gloss D, Harden C, Bourgeois B, Bautista JF, Abou-Khalil B, Burakgazi-Dalkilic E, Park EL, Stern J, Hirtz D, Nespeca M, Gidal B, Faught E, French J.
Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the American Epilepsy Society and the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.
Epilepsy Curr. 2018;18(4):260-268. PubMed abstract / Full Text

Kernan CL, Asarnow R, Siddarth P, Gurbani S, Lanphier EK, Sankar R, Caplan R.
Neurocognitive profiles in children with epilepsy.
Epilepsia. 2012;53(12):2156-63. PubMed abstract

Mula M, Kanner AM, Schmitz B, Schachter S.
Antiepileptic drugs and suicidality: an expert consensus statement from the Task Force on Therapeutic Strategies of the ILAE Commission on Neuropsychobiology.
Epilepsia. 2013;54(1):199-203. PubMed abstract

Posner E.
Absence seizures in children.
BMJ Clin Evid. 2008;2008. PubMed abstract / Full Text

Ramos-Lizana J, Aguirre-Rodríguez J, Aguilera-López P, Cassinello-García E.
Recurrence risk after withdrawal of antiepileptic drugs in children with epilepsy: a prospective study.
Eur J Paediatr Neurol. 2010;14(2):116-24. PubMed abstract

Rosati A, Ilvento L, Lucenteforte E, Pugi A, Crescioli G, McGreevy KS, Virgili G, Mugelli A, De Masi S, Guerrini R.
Comparative efficacy of antiepileptic drugs in children and adolescents: A network meta-analysis.
Epilepsia. 2018;59(2):297-314. PubMed abstract

Sidhu R, Velayudam K, Barnes G.
Pediatric seizures.
Pediatr Rev. 2013;34(8):333-41; 342. PubMed abstract

Tenney JR, Glauser TA.
The current state of absence epilepsy: can we have your attention?.
Epilepsy Curr. 2013;13(3):135-40. PubMed abstract / Full Text

Valentin A, Hindocha N, Osei-Lah A, Fisniku L, McCormick D, Asherson P, Moran N, Makoff A, Nashef L.
Idiopathic generalized epilepsy with absences: syndrome classification.
Epilepsia. 2007;48(11):2187-90. PubMed abstract

Weber YG, Lerche H.
Genetic mechanisms in idiopathic epilepsies.
Dev Med Child Neurol. 2008;50(9):648-54. PubMed abstract

Wheless JW, Clarke DF, Carpenter D.
Treatment of pediatric epilepsy: expert opinion, 2005.
J Child Neurol. 2005;20 Suppl 1:S1-56; quiz S59-60. PubMed abstract