Review Question - QID 217779

A young child with frequent, brief staring spells associated with redirection with calling of his name in the absence of neurological findings on an exam is suffering from staring spells for which the treatment is observation.

Staring spells are perfectly normal in childhood, although they must be distinguished from absence seizures. A key differentiating point is that absence seizures feature children (or adults) who are unable to be redirected by vocal or physical stimuli. Furthermore, an electroencephalogram may show the characteristic 3 Hertz spike-and-wave pattern. Staring spells can be broken with redirection and are common in childhood. There is no pathologic concern stemming from staring spells and the management entails observation and reassuring parents.

Albuja et al. explain how to evaluate a patient presenting for staring spells and discuss the management of absence seizures, which must be distinguished from staring spells.

Incorrect Answers:
Answer 1: Electrocardiogram is an appropriate step in a patient when there is a concern for syncope, which is defined as the sudden loss of blood flow to the brain, causing a momentary loss of consciousness. Patients with cardiac syncope experience sudden, abrupt onset of symptoms, but are not conscious nor are the syncopal episodes broken by vocal or physical stimuli.

Answer 2: Ethosuximide is the most appropriate first-line therapy for absence seizures, in which patients may present similarly but are unable to be redirected by vocal or physical stimuli. Additionally, patients may have lip-smacking and episodes do not often last several minutes.

Answer 3: Magnetic resonance imaging may be an appropriate next step in a patient that fully loses consciousness in an episode thought to be related to brain mass or stroke. Symptoms in such circumstances would be long-lasting and present with gross neurologic findings.

Answer 5: Valproic acid can be used in the management of absence seizures, but is not as strongly considered first-line as is ethosuximide. However, its role may be more suitable in patients with concomitant generalized tonic-clonic seizures. It is not an effective therapy for staring spells or daydreaming.

Bullet Summary:
Unlike absence seizures, a child with staring spells can be redirected with verbal or physical arousal, and treatment is merely observation.