A 9-year-old boy experiences episodes of sitting at his desk staring into space with brief unresponsiveness during class. He answers questions correctly and does not recall the episodes. What type of seizure is most likely?

• A. Absence
• B. Focal motor
• C. Temporal lobe
• D. Psychomotor

Answer: (A)

Absence seizures are at play here. They are generalized, nonconvulsive seizures that typically begin in childhood and cause a brief interruption of consciousness. The classic picture is a sudden stare or blank look with a momentary unresponsiveness, after which the child resumes activity and often has no memory of the event. The fact that the boy answers questions correctly and does not recall the episodes fits this pattern: awareness is briefly lost during the spell, then returns with no postictal confusion or long-lasting deficit. This distinguishes absence seizures from other seizure types.

Focal motor seizures would show activity starting in a specific body part with visible movements and intact or relative preservation of awareness except during the seizure. Temporal lobe (psychomotor/complex partial) seizures involve impaired consciousness with automatisms (lip-smacking, picking at clothes, wandering) and often postictal confusion. Those events tend to be longer and leave the patient with memory gaps after the episode. Absence seizures, by contrast, are brief, generalized, and quiet in their presentation, which is why this is the best fit. EEG often shows a characteristic 3 Hz spike-and-wave pattern during the episodes.