[Staring episodes in children with developmental disorders: epilepsy or behaviour?]

Area of Science:

• Neurology
• Developmental Pediatrics
• Child Psychiatry

Background:

• Differentiating behavioral staring episodes from epileptic seizures is challenging in children with developmental disorders like ADHD, autism spectrum disorders, and intellectual disabilities.
• Anti-epileptic drugs are sometimes used empirically for staring episodes, potentially masking underlying causes or causing side effects.

Observation:

• Two pediatric cases presented with staring episodes while on valproate, an anti-epileptic drug.
• Video-electroencephalogram (EEG) monitoring during staring episodes revealed no epileptic activity in either patient.
• The first patient, an 8-year-old boy with intellectual disability, experienced motor problems and ataxia, which resolved after valproate discontinuation. His staring was deemed behavioral.

Findings:

• The second patient, a 10-year-old boy with autism, ADHD, and a history of infantile seizures, also exhibited staring episodes while on valproate.
• Video-EEG confirmed non-epileptic staring in the second patient, attributed to his intellectual disability and autism.
• Valproate treatment was associated with motor issues in one case, resolving upon cessation.

Implications:

• Behavioral staring in children with developmental disorders requires careful differential diagnosis to avoid misdiagnosis of epilepsy.
• Video-EEG monitoring is crucial for accurately distinguishing non-epileptic staring from seizures.
• Understanding the behavioral underpinnings of staring in this population can prevent unnecessary anti-epileptic drug use and associated complications.