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Staring spells in children: descriptive features distinguishing epileptic and nonepileptic events
F Rosenow1, E Wyllie, P Kotagal
1Department of Neurology, Cleveland Clinic Foundation, Ohio 44195, USA.
Insights
Distinguishing epileptic absence seizures (AS) from nonepileptic staring (NES) in children is crucial. Key indicators for NES include preserved responsiveness and lack of play interruption, while limb twitches suggest AS.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Staring spells in children can be challenging to differentiate between epileptic absence seizures (AS) and nonepileptic staring (NES).
- Accurate diagnosis is essential for appropriate management and to avoid unnecessary anti-epileptic drug treatment.
Purpose of the Study:
- To identify specific historical questions that are sensitive and specific for differentiating between AS and NES in children.
- To improve the diagnostic yield of history-taking for children presenting with staring spells.
Main Methods:
- A parent-completed questionnaire was administered to 40 children presenting with staring spells.
- Data from 17 children diagnosed with AS and 23 with NES were compared.
Main Results:
- Features highly specific for NES (87-88%) included preserved responsiveness to touch, continued play, and initial identification by non-parents.
- Features highly specific for AS (91-100%) included limb twitches, upward eye movements, and urinary incontinence, though sensitivities were low.
- Body rocking was exclusively observed in NES, albeit with low sensitivity (13%).
Conclusions:
- In children with normal EEG and no neurological disease, staring spells are likely NES if parents report preserved responsiveness, body rocking, or teacher identification, and absence of limb twitches, upward eye movements, play interruption, or incontinence.
- A confident diagnosis of NES can be made in such cases, with long-term follow-up for confirmation.
Objective:
To identify questions sensitive and specific for staring spells of epileptic (absence seizures [AS]) or nonepileptic etiology to increase the yield of history taking.
Study Design:
A questionnaire was completed by parents of 40 children who presented with staring spells. Results from 17 children with AS and 23 with nonepileptic staring (NES) were compared.
Results:
Features with moderate sensitivity (43% to 56%) but high specificity (87% to 88%) for NES included preserved responsiveness to touch, lack of interruption of playing, and initial identification by a teacher or health professional. These features were more frequent in NES than in AS (P = .013, .016, .030). Body rocking occurred only in NES, but sensitivity was low (13%). Features with high specificity (91% to 100%) for AS included limb twitches, upward eye movements, and urinary incontinence; but sensitivities were low (13% to 35%).
Conclusion:
In children with normal interictal electroencephalography findings and without neurologic disease, staring spells are most likely nonepileptic when parents report preserved responsiveness to touch, body rocking, or initial identification by a teacher or health professional without limb twitches, upward eye movements, interruption of play, or urinary incontinence. In these cases a diagnosis of NES may be confidently applied, with confirmation based on long-term follow-up.