====== Differentiating between CAE and JAE ====== * Age at onset of CAE is considered to be 2 to 13 years of age and for Juvenile Absence Epilepsy (JAE) to be 8 to 20 years of age; there is five years of overlap[(:cite:pmid35503716>{{pmid>long:35503716}})]. * Patients with JAE more often have GTCS and more frequently experience seizure-related injuries compared with patients with CAE * Valproate can be considered as the drug of choice in men and lamotrigine as the first drug of choice in women with JAE. * CAE has a good prognosis (most patients will become seizure-free off ASMs[(:cite:pmid30856420>{{pmid>long:30856420}})], whereas in JAE many patients have poor seizure control and the syndrome may last a long time[(:cite:pmid24684814>{{pmid>long:24684814}})]. ^ Feature ^ CAE | JAE | | Age at onset | | | | Usual | 4–10 years | 9-13 yrs | | Range | 2–13; caution if diagnosing at <4yrs of age | 8–20 years; exceptional cases may present in adulthood | | Development | Typically normal, but may have learning difficulties or ADHD | Typically normal, but may have learning difficulties or ADHD | | Absences | | | | Frequency | At least daily to multiple per day but may be underrecognized by family | less than daily | | Duration | Typical duration = 3–20 s | Typical duration = 5–30 s | | Impaired awareness | Severe loss of awareness | Less complete impairment of awareness | | Other seizure types | | | | Febrile | Occasional | Occasional | | Generalized tonic-clonic seizures | Rarely precede or occur during period of frequent absences but may occur later with evolution to other IGE syndrome | May precede and commonly occur during the period of frequent absences | | Myoclonic | Prominent myoclonus exclusionary | Prominent myoclonus exclusionary | | EEG background | OIRDA in 21% | Normal | | Interictal epileptiform\\ discharge | | | | Awake | 2.5–4-Hz generalized spike-wave | 3–5.5-Hz generalized spike-wave | | Asleep | Polyspike and wave may be seen in drowsiness and sleep only | | | Irregular generalized spike-wave | Uncommon | More common than CAE | | Photoparoxysmal response | Rare\\ IPS triggers generalized spike-wave in 15%–21% but does\\ not induce seizures | Rare IPS triggers generalized spike-wave in 25% but does not induce seizures | | Hyperventilation induction | 87% | 87% | | ICTAL EEG | Regular 3-Hz (range = 2.5–4 Hz) generalized spikewave; 21% may have absences starting at 2.5-Hz spike-wave, and 43% may have absences starting at 4 Hz; if no generalized spike-wave is seen with hyperventilation for 3 min in an untreated patient, CAE can be excluded Disorganized dischargesa less frequent | Regular 3–5.5-Hz generalized spike-wave If no generalized spike-wave is seen with hyperventilation for 3 min in an untreated patient, JAE can be excluded Disorganized dischargesa 8 times more frequent than CAE | | Abbreviations: ADHD, attention-deficit/hyperactivity disorder; CAE, childhood absence epilepsy; EEG, electroencephalogram; IGE, idiopathic generalized epilepsy; IPS, intermittent photic stimulation; JAE, juvenile absence epilepsy; OIRDA, occipital intermittent rhythmic delta activity. a Disorganized discharges are defined as either brief (less than 1 sec and and transient interruptions in ictal rhythm or waveforms of different frequency or morphology during the ictal rhythm. |||