Evaluation of Patients Complaining of Staring Spells: Single Center Experience

Yıl 2024, ERKEN GÖRÜNÜMLÜ MAKALELER, 1 - 6

Pınar Ozbudak Deniz Menderes Canan Üstün Elif Perihan Öncel Deniz Yüksel

https://doi.org/10.12956/tchd.1431243

Öz

Objective: This study aimed to analyze the demographic characteristics, spell semiology, and electroencephalographic characteristics of children with a complaint of staring spells and determine the factors that differentiate epileptic and non-epileptic etiology.

Material and Methods: Fifty-six patients were included retrospectively between October 1, 2022, and December 1, 2023. The patients’ age, gender, co-morbidities, and other characteristics of the staring spells (duration, frequency, automatism, and presence of post-attack symptoms), access time to the pediatric neurologist, referring unit and access time to the final diagnosis were also recorded. Electroencephalography (EEG) was performed on all patients.

Results: Fifty-six patients were divided into two according to epileptic and non-epileptic etiology. Thirty-three patients (59%) were diagnosed with non-epileptic staring spells, 15 (26.7%) were diagnosed with generalized epilepsy, and 8 (14.3%) were diagnosed with focal epilepsy. The non-epileptic group had a longer spell time and spell frequency, the presence of verbal stimulation response, and no post-attack symptoms (p<0.001). The access time to the pediatric neurologist was detected as 5.5 days, and the access time to the final diagnosis was 6.6 days. EEG was diagnostic in 100% of the epileptic group. Most of the patients were referred by pediatricians and family physicians (p<0.001).

Conclusion: Identifying the cause of staring spells is crucial for further follow-up. In this study, we emphasized that history and routine EEG are important to determine the etiology. It has been observed that access time to pediatric neurologists and final diagnosis are shorter in our country compared to the literature. It can be concluded that pediatricians and family physicians have a high awareness of staring spells.

Anahtar Kelimeler

Childhood, epilepsy, staring spells, epileptic seizure

Etik Beyan

Declaration of Conflicting Interests: The authors did not recieve any funding fot this study and declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding:The authors received no financial support for the research, authorship, and/or publication of this article.

Göz Dalması Şikayetiyle Başvuran Hastaların Değerlendirilmesi: Tek Merkez Deneyimi

Öz

Amaç: Bu çalışmanın amacı, göz dalması atakları şikayeti olan çocukların demografik özelliklerini, atak semiyolojisini ve elektroensefalografik özelliklerini analiz ederek epileptik ve epileptik olmayan etiyolojiyi ayıran faktörleri belirlemektir.

Gereç ve Yöntemler: 1 Ekim 2022-1 Aralık 2023 arasında göz dalması şikayetiyle başvuran 56 hasta, retrospektif olarak incelendi. Hastaların yaşı, cinsiyeti, komorbiditeleri, dalmanın diğer özellikleri (süre, sıklık, otomatizma ve atak sonrası semptom varlığı), çocuk nöroloji hekimine ulaşma süreleri ve kim tarafından refere edildikleri sorgulandı. Tüm hastalara elektroensefalografi (EEG) uygulandı.

Bulgular: Ellialtı hasta epileptik ve epileptik olmayan etiyolojiye göre ikiye ayrıldı. Otuz-üç hastaya (%59) epileptik olmayan göz dalması, 15 hastaya (%26.7) jeneralize epilepsi, 8 hastaya (%14.3) ise fokal epilepsi tanısı konuldu. Epileptik olmayan gruptaki hastaların dalma süresinin ve atak sıklığının daha fazla olduğu, verbal uyarı yanıtının görüldüğü, atak sonrası semptomunun olmadığı saptandı (p<0.001). Dalma şikâyetiyle başvuran hastaların çocuk nöroloji hekimine ulaşma süresi 5.5 gün, hastaların sonuçlandırılma süresi 6.6 gün olarak hesaplandı. EEG epileptik grubun tamamında tanısaldı. Hastaların çoğu pediatrist ve aile hekimleri tarafından yönlendirilmişti (p<0.001).

Sonuç: Göz dalması şikayetinin nedenini belirlemek daha sonraki takip için çok önemlidir. Bu çalışmada etyolojinin belirlenmesinde öykü ve rutin EEG’nin önemi vurgulanmıştır. Ülkemizde pediatrik nörologlara erişim ve kesin tanı süresinin literatüre göre daha kısa olduğu görülmüştür. Ayrıca çocuk doktorları ve aile hekimlerinin göz dalması atakları konusunda farkındalıklarının yüksek olduğu söylenebilir.

Anahtar Kelimeler

Çocuk, epilepsi, epileptik nöbetler, göz dalması

Kaynakça

• Park EG, Lee J, Lee BL, Lee M, Lee J. Paroxysmal nonepileptic events in pediatric patients. Epilepsy Behav 2015;48:83–7.
• Armstrong-Javors A. Non-epileptic Paroxysmal Events. In: Handbook of Pediatric Epilepsy. Cham: Springer International Publishing 2022;177–97.
• Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B. Howwell can epilepsy syndromes be identified at diagnosis? A reassessment 2 years after initial diagnosis. Epilepsia 2000;41:1269–75.
• Khan A, Hussain N, Whitehouse WP. Evaluation of staring episodes in children. Arch Dis Child Educ Pract Ed 2012;97:202–7.
• Kim SH, Kim H, Lim BC, Chae CH, Kim KJ, Hwang YS. Paroxysmal nonepileptic events in pediatric patients confirmed by long-term video-EEG monitoring-Single tertiary center review of 143 patients. Epilepsy Behav 2012;24:336–40.
• Tatli B, Guler S. Non epileptic paroxysmal events in childhood. Turk Pediatri Ars 2017;52:59–65.
• Mclane HC, Berkowitz AL, Patenaude BN. Availability,accessibility, and affordability of neurodiagnostic tests in 37 countries. Neurology 2015;85:1614–22.
• Rosenow F, Wyllie E, Kotagal P, Mascha E, Wolgamuth BR, Hamer H. Staring spells in children: descriptive features distinguishing epileptic and nonepileptic events. J Pediatr 1998;133:660–3.
• Patel AD, Haridas B, Grinspan ZM, Stevens J. Utility of long-term video-EEG monitoring for children with staring. Epilepsy Behav 2017;68:186–91.
• Carmant L, Kramer U, Holmes GL, Mikati MA, Riviello JJ, Helmers SL. Differential diagnosis of staring spells in children: a video-EEG study. Pediatr Neurol 1996;14:199–202.
• Kotagal P, Wyllie E, Wolgamuth B. Paroxysmal non epileptic events in children and adolescents. Pediatrics 2002;110:e46.
• Goenka A, Reyes I, Fonseca LD, George MC, Stolfi A, Kumar G. Staring spells: An age-based approach toward differential diagnosis. J Child Neurol 2023;38:64–77.
• Kim S, Degrauw T, Berg AT, Koh S. Staring spells: How to distinguish epileptic seizures from nonepileptic staring. J Child Neurol 2022;37:738–43.
• Elmazny A, Alzayani S, Shehata MH, Magdy R. Knowledge, awareness, and attitudes towards epilepsy among elementary schoolteachers in the Kingdom of Bahrain. Eur J Paediatr Neurol 2023;47:13–7.
• Goenka A, Fonseca LD, Kumar G. Demographic and geographic variations in the access time of pediatric patients presenting with staring spells. Epilepsy Behav 2023;145:109299.