50 Years Ago in The Journal of Pediatrics:

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Senz EH. J Pediatr 1958;53:441-5

Both l'Académie Française and the International League Against Epilepsy (ILAE) share a history of consternation about the improper use of French words. The term petit mal, or a little illness, has been misused for more than a century by physicians and laypersons alike to describe any minor seizure. However, Jean Esquirol coined the term petit mal seizures in 1838 for specific childhood spells described earlier by Parisian neurologists.¹ Fifty years ago in The Journal, Senz bemoaned the continued use of the term petit mal “to designate any brief convulsive attack which lacks the features of a grand mal attack.”

Although these French terms would best be retired, as the ILAE has long hoped, their use pervades medicine. Petit mal seizures—more appropriately absence seizures—are <30-second staring spells, often with fluttering or closed eyelids, which end abruptly. These spells occur many times daily, are provoked often by hyperventilation or photic stimulation, display 3-cycle per second generalized spike-wave activity on electroencephalography (EEG), and are treated with ethosuximide or valproic acid, or sometimes lamotrigine or zonisamide. Carbamazepine exacerbates absence seizures.

Absence seizures are distinct from the other “minor seizures,” principally complex partial seizures.² Although the ILAE now advocates replacing the word “partial” with “focal,” the term complex partial seizure is entrenched. Complex partial seizures, although confused with petit mal seizures, arise focally in the brain, perhaps with underlying pathology or at least focal discharges on EEG, and last 1-2 minutes, with unilateral motor manifestations. An aura may precede the seizure, and behavioral automatisms are common during the spell. Carbamazepine, oxcarbazepine, or sometimes valproic acid or levetiracetam successfully treat these seizures in children.

Although the ILAE will continue to strive to distinguish the terminology and semiology of absence and focal seizures, clinicians would best educate themselves and patients, as Senz reminds us, that petit mal, or absence, seizures are a disorder clinically distinct from other minor seizures and not a little sister of grand mal seizures. S'il vous plaît employez le mot juste!

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References 

1. Esquirol J. De l' épilepsie. In: Traite des maladies mentale. Vol 1:Paris: Baillière Publishers; 1838;p. 274–355
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2. http://www.ilae-epilepsy.orgAccessed April 28, 2008
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