Staring spells are brief periods of unresponsiveness that can be easily mistaken for simple inattention or daydreaming, particularly when they occur in children. These events represent a type of seizure activity, indicating a temporary, abnormal burst of electrical signaling within the brain. Recognizing these episodes as a medical concern, rather than a behavioral issue, is the first step toward appropriate diagnosis and management.
Defining Absence Seizures
The most common form of staring spell is known clinically as an absence seizure, which was historically referred to as a petit mal seizure. This type of event is characterized by a sudden, momentary lapse of consciousness where the individual appears to simply stop what they are doing and stare blankly into space. Absence seizures typically begin and end abruptly, with a duration that usually ranges from 5 to 15 seconds.
During the seizure, the person is completely unaware of their surroundings and will not respond to verbal commands or physical stimuli. Although the primary feature is the vacant stare, subtle movements may accompany the episode, such as fluttering eyelids, lip smacking, or slight hand movements. The underlying cause is a brief, generalized electrical disturbance involving the entire brain.
The individual immediately resumes their activity upon the seizure’s termination, often having no memory of the event or the lost time. This immediate return to a normal state, without any post-seizure confusion or drowsiness, is a defining characteristic of a typical absence seizure. These seizures are most common in childhood, typically beginning between the ages of 4 and 14 years, with a peak onset between 5 and 8 years.
Distinguishing Types of Staring Spells
While the typical absence seizure is the most recognized staring spell, not all episodes of unresponsiveness are the same, and distinguishing between types is important for treatment. Absence seizures are classified as a generalized seizure type, meaning the electrical disturbance involves both sides of the brain simultaneously.
A different type of event that can involve staring is a Focal Impaired Awareness Seizure (FIAS), previously called a complex partial seizure. These seizures originate in a specific area of one hemisphere of the brain, resulting in impaired awareness. FIAS episodes tend to be noticeably longer than absence seizures, frequently lasting 30 seconds up to two minutes.
A key differentiator is the potential for FIAS to include more pronounced automatisms, which are repetitive, non-purposeful behaviors like fidgeting with clothes, rubbing the hands, or complex chewing movements. Furthermore, FIAS may begin with an aura, which is a subjective sensation like a strange smell, déjà vu, or a rising feeling in the stomach, which signals the start of the seizure. A period of confusion or disorientation, known as a post-ictal state, is common after a focal impaired awareness seizure, which is a clear contrast to the immediate recovery seen after an absence seizure.
Diagnosis and Medical Evaluation
A diagnosis of a seizure disorder begins with a detailed history from the patient and any eyewitnesses, as the subtle nature of staring spells means the patient is often unaware they have occurred. The clinical description of the event—specifically the duration, whether any movements occurred, and the recovery time—helps the medical professional determine the seizure type. In some cases, rapid, deep breathing (hyperventilation) can be used during an evaluation, as this technique is known to provoke an absence seizure in susceptible individuals.
The most informative diagnostic tool is the Electroencephalogram (EEG), which records the electrical activity of the brain using electrodes placed on the scalp. During a typical absence seizure, the EEG displays a characteristic pattern of generalized spike-and-wave discharges occurring at a frequency of three cycles per second (3 Hz).
Medical evaluation may also include neuroimaging, such as a Magnetic Resonance Imaging (MRI) scan, to rule out underlying structural causes. Although absence seizures are typically genetic, imaging helps ensure that symptoms are not the result of a tumor, stroke, or other physical damage.
Treatment and Long-Term Outlook
The management of absence seizures primarily involves anti-seizure medications (ASMs) designed to stabilize the abnormal electrical activity in the brain. Ethosuximide is often the first medication prescribed for typical absence seizures, as it is highly effective and well-tolerated. Valproic acid is another effective option, particularly if the patient experiences both absence seizures and other seizure types, such as generalized tonic-clonic seizures.
Other ASMs, like lamotrigine, may be used, though they may be less effective than ethosuximide or valproic acid. Lifestyle adjustments, such as consistently getting adequate sleep and avoiding hyperventilation, are important supportive measures, as these factors can sometimes trigger seizures. A few individuals may also benefit from a ketogenic diet, a high-fat, low-carbohydrate regimen used when medications alone do not control seizures.
The long-term outlook for childhood absence epilepsy is generally favorable, with a high chance of eventual seizure freedom. A significant number of children outgrow their absence seizures by mid-adolescence. Their medication can often be slowly tapered off under medical supervision after they have been seizure-free for a period. A small percentage of children, however, may continue to experience seizures or develop other types of seizures later in life.