An 8-year-old boy is admitted for seizures described as '20-second lapses of awareness' when he blinks his eyes. Which seizure type is most likely?

• A. Tonic-clonic
• B. Myoclonic
• C. Focal
• D. Absence

Answer: (D)

This item tests recognizing absence seizures in children. Absence seizures are brief periods of impaired consciousness with minimal motor activity, often presenting as a sudden stare or eyelid fluttering. They typically last about 5 to 20 seconds. An 8-year-old with 20-second lapses of awareness occurring with blinking fits this pattern and explains why absence is most likely. After these episodes, there’s usually no postictal confusion, which helps distinguish absence from generalized tonic-clonic seizures (which involve tonic stiffening, clonic jerking, and a postictal state). Myoclonic events involve quick, isolated jerks rather than a sustained lapse of awareness. Focal seizures start in a specific brain area and usually have recognizable focal symptoms or impaired awareness with focal features, not just brief lapses tied to blinking. EEG in absence often shows 3 Hz spike-and-wave discharges.