Abstract
Objective: This study aimed to analyze the demographic characteristics, spell semiology, and electroencephalographic characteristics of children with a complaint of staring spells and determine the factors that differentiate epileptic and non-epileptic etiology.
Material and Methods: Fifty-six patients were included retrospectively between October 1, 2022, and December 1, 2023. The patients’ age, gender, co-morbidities, and other characteristics of the staring spells (duration, frequency, automatism, and presence of post-attack symptoms), access time to the pediatric neurologist, referring unit and access time to the final diagnosis were also recorded. Electroencephalography (EEG) was performed on all patients.
Results: Fifty-six patients were divided into two according to epileptic and non-epileptic etiology. Thirty-three patients (59%) were diagnosed with non-epileptic staring spells, 15 (26.7%) were diagnosed with generalized epilepsy, and 8 (14.3%) were diagnosed with focal epilepsy. The non-epileptic group had a longer spell time and spell frequency, the presence of verbal stimulation response, and no post-attack symptoms (p<0.001). The access time to the pediatric neurologist was detected as 5.5 days, and the access time to the final diagnosis was 6.6 days. EEG was diagnostic in 100% of the epileptic group. Most of the patients were referred by pediatricians and family physicians (p<0.001).
Conclusion: Identifying the cause of staring spells is crucial for further follow-up. In this study, we emphasized that history and routine EEG are important to determine the etiology. It has been observed that access time to pediatric neurologists and final diagnosis are shorter in our country compared to the literature. It can be concluded that pediatricians and family physicians have a high awareness of staring spells.
Keywords: Childhood, epilepsy, staring spells, epileptic seizure
References
- Park EG, Lee J, Lee BL, Lee M, Lee J. Paroxysmal nonepileptic events in pediatric patients. Epilepsy Behav 2015;48:83–7.
- Armstrong-Javors A. Non-epileptic Paroxysmal Events. In: Handbook of Pediatric Epilepsy. Cham: Springer International Publishing 2022;177–97.
- Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B. Howwell can epilepsy syndromes be identified at diagnosis? A reassessment 2 years after initial diagnosis. Epilepsia 2000;41:1269–75.
- Khan A, Hussain N, Whitehouse WP. Evaluation of staring episodes in children. Arch Dis Child Educ Pract Ed 2012;97:202–7.
- Kim SH, Kim H, Lim BC, Chae CH, Kim KJ, Hwang YS. Paroxysmal nonepileptic events in pediatric patients confirmed by long-term video-EEG monitoring-Single tertiary center review of 143 patients. Epilepsy Behav 2012;24:336–40.
- Tatli B, Guler S. Non epileptic paroxysmal events in childhood. Turk Pediatri Ars 2017;52:59–65.
- Mclane HC, Berkowitz AL, Patenaude BN. Availability,accessibility, and affordability of neurodiagnostic tests in 37 countries. Neurology 2015;85:1614–22.
- Rosenow F, Wyllie E, Kotagal P, Mascha E, Wolgamuth BR, Hamer H. Staring spells in children: descriptive features distinguishing epileptic and nonepileptic events. J Pediatr 1998;133:660–3.
- Patel AD, Haridas B, Grinspan ZM, Stevens J. Utility of long-term video-EEG monitoring for children with staring. Epilepsy Behav 2017;68:186–91.
- Carmant L, Kramer U, Holmes GL, Mikati MA, Riviello JJ, Helmers SL. Differential diagnosis of staring spells in children: a video-EEG study. Pediatr Neurol 1996;14:199–202.
- Kotagal P, Wyllie E, Wolgamuth B. Paroxysmal non epileptic events in children and adolescents. Pediatrics 2002;110:e46.
- Goenka A, Reyes I, Fonseca LD, George MC, Stolfi A, Kumar G. Staring spells: An age-based approach toward differential diagnosis. J Child Neurol 2023;38:64–77.
- Kim S, Degrauw T, Berg AT, Koh S. Staring spells: How to distinguish epileptic seizures from nonepileptic staring. J Child Neurol 2022;37:738–43.
- Elmazny A, Alzayani S, Shehata MH, Magdy R. Knowledge, awareness, and attitudes towards epilepsy among elementary schoolteachers in the Kingdom of Bahrain. Eur J Paediatr Neurol 2023;47:13–7.
- Goenka A, Fonseca LD, Kumar G. Demographic and geographic variations in the access time of pediatric patients presenting with staring spells. Epilepsy Behav 2023;145:109299.
