STARING SPELLS IN CHILDREN - DESCRIPTIVE FEATURES DISTINGUISHING EPILEPTIC AND NONEPILEPTIC EVENTS

Objective: To identify questions sensitive and specific for staring sp ells of epileptic (absence seizures [AS]) or nonepileptic etiology to increase the yield of history taking. Study design: A questionnaire wa s completed by parents of 40 children who presented with staring spell s. Results from 17 children with AS and 23 with nonepileptic staring ( NES) were compared. Results: Features with moderate sensitivity (43% t o 56%) but high specificity (87% to 88%) for NES included preserved re sponsiveness to touch, lack of interruption of playing, and initial id entification by a teacher or health professional. These features were more frequent in NES than in AS (P =.013,.016,.030). Body rocking occu rred only in NES, but sensitivity was low (13%). Features with high sp ecificity (91% to 100%) for AS included limb twitches, upward eye move ments, and urinary incontinence; but sensitivities were low (13% to 35 %). Conclusion: In children with normal interictal electroencephalogra phy findings and without neurologic disease, staring spells are most l ikely nonepileptic when parents report preserved responsiveness to tou ch, body rocking, or initial identification by a teacher or health pro fessional 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 longterm follow-up.