When does a staring child need an EEG?

Generalized absence seizures vs non-epileptic staring

This table provides a useful structured approach to clinically deciding if staring is epileptic or non-epileptic:

Generalized absence seizures

  • Abrupt onset/offset.
  • Interrupting preferred activity/play abruptly.
  • Staring through someone, up-rolling of the eyeballs, twitching movements of the eyelids or face/urinary incontinence.
  • High frequency (multiple daily in childhood), at least daily (in adolescence).
  • Hyperventilation (the child blowing with good deep breaths for 1.5-2 minutes) produces a typical clinical absence seizure (if not facilitated by hyperventilation, absences are unlikely).

Non-epileptic staring

  • Seen in situations of daydreaming, imagining, when bored or drifting into drowsiness (evenings, after food, in car-seats).
  • Seen during non-preferred activity, during stressful or over-stimulating circumstances.
  • First reported by teachers/therapists/health professionals but not noted by parents.
  • Staring off into the distance.
  • Frequency – episodic, here and there.
  • Respond to vigorous touch or intrusive contact (e.g. tapping nose, flicking eyelashes).
  • Seen with body rocking movements or self-soothing behaviours.