Approximately 50% were referred by an emergency department, 48% by a primary care physician, and 2% by an urgent care clinic. Of the 62 cases that turned out to be nonepileptic events, about 61% were referred by primary care physicians.
MRI Findings in Patients With Focal Seizures
On average, patients with nonepileptic staring were younger at the initial clinic presentation and at staring spell onset. Patients with nonepileptic staring had an average age of 4.8 at their initial visit, whereas patients with focal seizures had an average age of 6.3. Patients with absence seizures had an average age of 8.3.
Patients with nonepileptic events were more likely to have developmental delay (approximately 35%) versus patients with focal seizures (23%) or absence seizures (8%).
Absence epilepsy was diagnosed in 24 patients (20%), and focal epilepsy in 35 patients (29%).
Of the 59 cases of epileptic staring, 46% (n = 27) were classified as syndromic; 36% (n = 21) had childhood absence epilepsy, and 5% (n = 3) had juvenile absence epilepsy. In addition, there was one case each of mesial temporal lobe epilepsy with hippocampal sclerosis, Panayiotopoulos syndrome, and generalized epilepsy with febrile seizures.
About one-third of patients received MRI, and seven patients had etiologically relevant findings (eg, brain tumor, malformation of cortical development, and periventricular leukomalacia). All of the patients with abnormal MRIs had focal seizures.
“An NOS clinic ... can provide rapid, accurate diagnoses for staring spells,” said Dr. Kim. “This is important, as children with nonepileptic events should not be given the diagnosis of epilepsy, and their events should not be treated with seizure medications. Similarly, children who have epileptic seizures require accurate diagnosis, as the treatment depends on the seizure type.”