Staring Spells: An Age-based Approach Toward Differential Diagnosis
- 13 November 2022
- journal article
- research article
- Published by SAGE Publications in Journal of Child Neurology
- Vol. 38 (1-2), 64-77
- https://doi.org/10.1177/08830738221134552
Abstract
Evaluations to rule out epileptic vs nonepileptic staring spells may entail unnecessary evaluations that can be costly and time consuming. Our study aims to identify common etiologies for staring spells across 3 different pediatric age groups and to propose an age-based clinical guidance to help determine which patients warrant further workup. Methods: This was a single-center retrospective chart analysis of 1496 patients aged 0.0-17.9 years presenting with confirmed staring spell diagnosis from January 2011 to January 2021. The patients were divided into 3 groups based on their age: 0.0-2.9, 3.0-12.9, and 13.0-17.9 years. Patient information collected included demographics, clinical presentation, comorbidities, and final diagnosis. Multilevel likelihood ratios and a receiver operating characteristic curve were determined using 8 of the 11 clinical variables. A total of 1142 patients who met the inclusion criteria were included for the final analysis. The most common final diagnosis was attention-deficit hyperactivity disorder (ADHD) (35%), followed by normal behavior (33%). Generalized and focal epilepsy were diagnosed in 8% and 4% of the patients, respectively. In the 0.0-2.9-year age group, normal behavior was the final diagnosis in 72% patients. In the 3.0-12.9-year and 13.0-17.9-year age groups, ADHD was the most frequent final diagnosis in 46% and 60%, respectively. Overall, ADHD and normal behaviors remain the most common final diagnoses. Multilevel likelihood ratios can be used to develop an age-based guidance to differentiate between epileptic and nonepileptic staring spell diagnoses.Keywords
This publication has 25 references indexed in Scilit:
- Nonepileptic paroxysmal events in a pediatric populationEpilepsy & Behavior, 2010
- Magnetic Resonance Imaging Findings in Children With a First Recognized SeizurePediatric Neurology, 2008
- Nonepileptic Seizures in ChildrenEpilepsia, 2007
- The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal eventsArchives of Disease in Childhood, 2006
- Diagnoses made in a secondary care "fits, faints, and funny turns" clinicArchives of Disease in Childhood, 2006
- The diagnostic value of initial video-EEG monitoring in children—Review of 1000 casesEpilepsy Research, 2005
- Paroxysmal non‐epileptic events in children: A retrospective study over a period of 10 yearsJournal of Paediatrics and Child Health, 2000
- Differential diagnosis of staring spells in children: A video-eeg studyPediatric Neurology, 1996
- EEG Abnormalities in Children with a First Unprovoked SeizureEpilepsia, 1994
- Staring Episodes in Children Analyzed by TelemetryJournal of Child Neurology, 1992