video camera

Patel AD, Haridas B, Grinspan ZM, Stevens J. In Epilepsy & Behavior 2017: 68: 186- 91.

Purpose

Staring spells are a common reason for admission to the pediatric epilepsy monitoring unit (PEMU) due to concern that these spells represent absence seizures as a symptom of childhood-onset epilepsy.

Though the clinical exam and a routine outpatient electroencephalogram (EEG) are important parts of the evaluation, capturing a typical event with video EEG monitoring is the gold standard for diagnosis, typically requiring admission to the PEMU. At the same time, admission to the PEMU requires a significant time commitment from the patient and family and is an expensive test.

Due to staring spells being a relatively common complaint, and limitations of a PEMU admission, the authors set out to evaluate the utility of a PEMU admission when the chief complaint is staring.

Description of Study

  • A four-year retrospective review of PEMU admissions was performed at a single tertiary care hospital.
  • All children with an admission diagnosis of staring spells were included.
  • They identified 276 individual unique patients and admissions.
  • The authors then reviewed relevant medical history:
    • prior diagnosis of epilepsy
    • other prior diagnosis
    • outpatient EEG findings
  • Finally, they analyzed the results of the PEMU admission and performed statistics to correlate PEMU findings with pre-admission data.

Summary of Study Findings

  • Of the 276 children admitted to the PEMU for staring spells, in only 11% were the staring spells determined to be seizures.
  • A normal outpatient EEG prior to admission strongly correlated with staring spells being nonepileptic.
  • The presence of automatisms (repeated non-purposeful movements), a prior diagnosis of epilepsy, and baseline medications for epilepsy all were associated with staring spells representing seizures.
  • The authors developed a scoring scale to predict staring spells as seizures:
    • Prior EEG known to be normal is -3 points; medication for psychiatric condition is -1 points;anti-epileptic drug for epilepsy +1 point; and spells lasting less than 1 minute +1 point
    • A negative score indicates staring spells are rarely seizures; 0 indicates staring spells are uncommonly seizures; 1 point indicates staring spells are occasionally seizures; and 2 points indicates staring spells are commonly seizures

What does this mean?

In children being admitted to the PEMU for staring spells, a minority will ultimately be found to have seizures.
A normal outpatient EEG makes a diagnosis of seizures less likely.
In patients with known epilepsy, staring spells are more likely to represent seizures.

Article published in Epilepsy & Behavior, March 2017.

Authored By: 
Amy Z. Crepeau MD
Authored Date: 
06/2017