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Evaluation of staring episodes in children
  1. Arif Khan1,
  2. Nahin Hussain1,
  3. William P Whitehouse2
  1. 1Department of Paediatric Neurology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
  2. 2Department of Paediatric Neurology, University of Nottingham, Nottingham Children's Hospital, Nottingham University Hospital's NHS Trust, Queens Medical Centre, Nottingham, UK
  1. Correspondence to Dr Arif Khan, Department of Paediatric Neurology, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK, khangoa{at}hotmail.com

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Introduction

Staring episodes are a frequent reason for referral to paediatrics, as parents and teachers fear the possibility of seizures. Staring episodes in childhood are common and a challenging clinical problem. The difficulty is in differentiating between epileptic and non-epileptic phenomenon at the first assessment. Clear description of the event, preferably by a first-hand eye witness, along with clinicians’ clinical experience will usually lead to a correct categorisation of the episodes. Rarely, a clinician will be able to actually observe the phenomenon; therefore a video recording of an event is invaluable.

The differential diagnosis of staring spells in children can be broadly categorised into absence seizures (‘typical’ in a ‘normal’ child and ‘atypical’ in a child with developmental problems), complex partial seizures (CPS), daydreaming and childhood preoccupation. To achieve an accurate diagnosis a comprehensive approach including a systematic clinical assessment and judicious use of investigations is necessary.

However, it should be remembered that as paediatricians we work with children of varying ages and maturity levels, in addition to the underlying neurological impairments that may exist. There is often a lack of information, description and insight into these events. Therefore, the proportion of ‘misdiagnosis’ in epilepsy in this population (infants, young children and neurologically impaired children) is substantial.1 ,2

A simple approach and categorisation of these events is offered here to help the clinician in making an accurate diagnosis.

Staring episodes in children can be broadly divided into non-epileptic and epileptic events.

Non-epileptic staring episodes

Daydreaming

Daydreaming in children is common. Those children who are referred for evaluation are more likely to have comorbid conditions such as attention deficit hyperactivity disorder (ADHD), learning difficulties and Tourette syndrome. These episodes usually occur during periods of inactivity or when a child finds the activity less interesting. Children during daydreaming tend to ignore verbal stimulation, but usually …

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