When a Child Stares Without Responding

When a Child Stares Without RespondingAs a pediatric neurologist, I sometimes examine young patients for “staring.” When a parent reports that their child “ stares ,” “ blanks out ” or “ zones out ,” they also report the child doesn’t come out of it until their name is called several times. If it gets to this point, the parent is likely shouting their name.

The question is: are these blank stares actually seizures?

The medical profession has recently sought to educate the public about various medical conditions. For pediatric neurology, our profession has addressed parent and teacher groups about “absence seizures” (formerly known as “petit mal seizures”).

During an absence seizure, a child’s brain consciousness system becomes locked into a non-functional state with a type of electrical rhythm that completely interferes with his or her attention and reception of environmental stimuli. He or she stares blankly and is totally unaware of what’s going on for 10 to 15 seconds. When the absence seizure ends, the child goes right back to what they were doing — as if nothing ever happened. They don’t realize they don’t see or hear anything during that brief period.

When a child has absence seizures, they usually happen frequently, maybe dozens of times a day. But they’re so brief; it’s hard to always catch them.

Another characteristic of absence seizures is that they interrupt the normal flow of an activity, like running, talking or writing. For example, one patient hit a baseball and begin to run to first base. He stopped and stared halfway there for a few seconds. He started to run again. Absence seizures can be embarrassing and even dangerous.  If an absence seizure occurred while riding a bicycle instead of running bases, there could be potential for a serious accident.

Teachers are often the first to see absence seizures. They are face-to-face with a child more than a working parent, who may be facing their child only at meal times. If a parent talks to a child during dinner, they may be thinking about something that happened in school that day. They may not respond until they have finished the scene that is playing out in their mind.

So how do doctors decide if the staring is a seizure or just daydreaming?

Gently spray or splash water in a child’s face while staring. Was the reaction: “Why did you do that?” Or did they say, “How did I get wet?” Similarly, tickle a child’s nose with a napkin or tissue. If the child is completely oblivious to being stimulated, whether with a tissue or water, then it’s a good bet it’s a seizure.

Electroencephalogram (EEG) is a test used to detect these seizures. For this, a technician applies electrodes to the child’s head and records the electrical brain activity while awake and sleeping. If the child has an absence seizure during the test, it will show the abnormal electrical activity.

If the EEG is positive for absence seizures, the treatment is medication. This type of seizure responds well to medical treatment. The goal is to stop the spells completely for two years, then repeat the EEG and — if it shows no abnormal activity — gradually discontinue the medication. Seizures later on in adolescent years that require more medication are rare.

My greatest professional satisfaction comes from treating a child for seizures and being able to eventually discontinue their medication and send them on their way.

Winslow J. BokowskiArticle is written by:
Winslow J. Bokowski, M.D., M.P.H
Pediatric Neurologist
Bon Secours St. Mary’s Hospital

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