Silent or Absence Seizure and How it Affects Autism Treatment and Diagnosis

Dr. Insana Mazumdar
Jul 8
4 min read

What is silent or absence seizure?

As per definition by Cleveland Clinic (Cleveland Clinic, n.d.)¹ in its website, “Absence seizures are short seizures that happen without warning and usually last for a few seconds. They’re more common in children but adults can have absence seizures, too. Absence seizures are often mistaken for daydreaming or a lack of attention. Antiseizure medications treat this type of seizure.”

In our clinic, we have several cases, which we recognised as silent seizure cases. They come with a diagnosis of high autism spectrum as these children were not responding to the usual therapy methods, accompanied by little to no improvements in speech, listening ability, participation in school activities, constant staring, zero response to teacher’s prompts, etc.

Through our understanding of having worked with such cases, we suggest the parents/guardians for a consultation with a Paediatric Neurologist experienced in handling such cases. A proper medical treatment plan is necessary before a standard therapy strategy is followed.

What are the difficulties associated with silent seizures?

Any activity, while at school or at home, requires the full attention of the brain to perform normally. Silent seizures can affect such activities and some of the complications you can see with children are:

· Low attention to school activities

· Constant staring or low focus on task in hand

· Difficulty to follow prompts by teachers or parents

· Learning challenges which may put him/her at a disadvantage than their peers

Why is it difficult to diagnose silent seizures in autism patients?

Children with special needs are at highest risk from silent seizures as most of the traits mentioned above may be misdiagnosed as symptoms of them being autistic. It is like a quagmire of undiagnosed loop where they get stuck and do not get the right treatment on time, which would have otherwise helped them along with the occupational therapy they have been receiving.

As per a joint research (Goenka A, 2023)² done by the Dayton’s Children’s Hospital, USA and Wright State University, USA, out of their 140-test group of autism children with staring spells, 118 were found to have diagnosed with non-epileptic spells or silent seizures. This shows how persistent it is among children suffering from autism.

Another research (Kim, 2022)³ with a test group of 121 patients suffering from staring spells, “Sixty-two of 121 (51%) children were diagnosed with nonepileptic staring spells and 59 (49%) with epileptic seizures (24 with absence epilepsy, 35 with focal epilepsy). Patients with nonepileptic staring spells were younger (4.8 vs 7.1 years, P = .001) and more likely to have developmental delay (P = .005) than the seizure group.”

This shows the dangers of absence seizures in the path of developmental therapy for autistic children without a proper diagnosis and treatment.

How is silent seizure diagnosed and managed/treated?

Our first symptom which we pick up as Occupational Therapists when we are treating a child with autism is that there are some abnormalities in outcomes as per the treatment they are receiving accompanied by staring spells, relapses in the progress, etc. It’s more difficult to have tell-tale signs as compared to non-autistic children as the symptoms often mirror similarities in autism traits. That is why, any doubt we have, we suggest our patients’ parents/guardians for cautionary diagnosis to rule out as caution is better than regret.

We ask the patients to consult a Neurologist for further diagnosis which will confirm our suspicions. The doctor usually suggests EEG (Electroencephalogram), which is the best method to capture any abnormalities seen in the brain’s electrical activity during silent seizure. It is easily managed or treated with the help of antiseizure medicines as prescribed by the doctor.

Unfortunately, silent seizure is something which cannot be preventable. It can manifest itself without any reason. Thus, only treatment is the best option.

Case Study:

Akash (name changed), aged 3 at that time, came to our clinic in February 2023 with parents complaining of severe autism traits which are not showing any signs of improvement even after 4 months of therapy. He also had severe speech developmental delays with zero sentence constructions. I was doing his evaluations as usual before taking the case, as standard procedure to understand his severity and formulate a therapy plan; when I noticed some of the symptoms associated with silent seizures. Sudden loss of focus while having a conversation tends to zone into a staring spell. Also, as per his parents, the therapy has not made any improvements, in fact things were getting worse in terms of his autism traits.

I suggested the parents to consult one of the prominent Paediatric Neurologist in Kolkata who was experienced in handling cases like these. She suggested a sleep EEG test to check Akash’s brain wave pattern. Diagnosis came and as suspected, he was having episodes of silent seizures. He was put on a medication of Valpro.

After his diagnosis and medication, I resumed the therapy plan modified to his requirements. Within a few months, his condition improved. He can formulate complete sentences and 60% of his autism traits were reduced, making him well prepared for an Inclusive School.

This case shows how important it is to rule out silent seizures in suspected autistic children, which otherwise would hold them back from the progress they would have shown with the right treatment. I have many more cases after that and as research has also shown repeatedly, we need more awareness on silent seizures affecting treatment plans for autistic children.

References

(n.d.). Retrieved from Clevelend Clinic: https://my.clevelandclinic.org/health/diseases/22194-absence-seizures

Goenka A, F. L. (2023). Staring spells in children with autism spectrum disorder: A clinical dilemma. Autism : the international journal of research and practice, 1407–1416.