What Are Staring Spells? Symptoms, Causes, and Treatment

Staring spells are brief episodes in which a person, usually a child, appears to “blank out” and become unresponsive, gazing fixedly without reacting to voices or touch. About half the time, these episodes turn out to be epileptic seizures, and about half the time they are something else entirely. One study of 121 children referred for evaluation of staring spells found that 51% had nonepileptic causes and 49% had epileptic seizures.¹ That near-even split is exactly why staring spells deserve careful attention rather than quick assumptions in either direction.

What a Staring Spell Looks Like

The hallmark of a staring spell is a sudden pause in activity. The person stops talking, stops moving, and stares ahead with a blank expression. In young children this is often described by parents or teachers as “zoning out.” If the underlying cause is an absence seizure, the episode is typically very short. A study of 339 absence seizures in children with childhood absence epilepsy found an average seizure duration of about 9 seconds, with the main features being arrest of activity, loss of awareness, staring, and rhythmic eyelid movements at roughly three per second.² These episodes end just as abruptly as they start, and the person usually picks up right where they left off, often unaware that anything happened.

Not all staring spells share these features. Focal seizures, which arise from a specific region of the brain rather than involving both hemispheres simultaneously, tend to last longer. In the same study of 121 children, focal seizures typically lasted more than a minute in about 83% of cases, compared with about 31% of nonepileptic staring spells.¹ A focal seizure might also involve subtle movements on one side of the body, lip smacking, or confusion afterward, which can help distinguish it from a classic absence seizure.

Why Some Staring Spells Are Seizures and Some Are Not

When staring spells are seizures, the two main types are absence seizures and focal seizures. Absence seizures are the type most people associate with childhood staring spells. They involve a brief, generalized disruption in brain activity, typically showing up on an EEG as a distinctive three-per-second spike-and-wave pattern. Focal seizures, by contrast, start in one part of the brain and may or may not spread. Both can look like a child simply spacing out, which is why an EEG is so important for sorting them out.

But a large fraction of staring spells have no epileptic basis at all. In children, nonepileptic staring spells are common and can stem from daydreaming, developmental differences, or inattention. The differential diagnosis is actually broader in children than in adults, because there are many nonepileptic, nonpsychogenic conditions unique to childhood, including breath-holding spells and shudder attacks.³ Some children simply have brief moments of disengagement that look dramatic to an observer but involve no abnormal electrical activity in the brain.

In a smaller number of cases, staring spells fall into the category of psychogenic nonepileptic seizures, sometimes called PNES. These episodes look like seizures but are driven by psychological rather than electrical causes. Research on children with PNES has identified several common contributing factors, including a history of violence, abuse, or neglect; high anxiety; dysfunctional family dynamics; and patterns of avoidance behavior.⁴ These episodes are not faked or intentional; they are a real physical manifestation of psychological distress.

How Doctors Figure Out What Is Going On

The single most important tool is the electroencephalogram, or EEG. During an EEG, electrodes on the scalp record the brain’s electrical activity. If a staring spell happens to occur during the recording and the EEG shows seizure-pattern activity, the diagnosis is clear. For absence seizures in particular, the EEG is extremely reliable. In one study, it was diagnostic in 100% of children with absence seizures.¹ For focal seizures the yield was lower, capturing the diagnosis about half the time, because focal seizures are less predictable and may not occur during a short recording.

During a routine EEG, doctors often ask the child to breathe deeply and rapidly for several minutes. This hyperventilation is one of the most reliable ways to trigger an absence seizure in a clinic setting. One study found that 85% of children with known absence epilepsy had a seizure provoked during hyperventilation, and the position of the child mattered: all seizures occurred while the child was sitting upright, compared with about 65% while lying down.⁵

When a routine EEG does not capture an episode, a longer stay in a video-EEG monitoring unit may be needed. This involves recording the child continuously over one or more days. The results, however, can be sobering. One analysis of 276 admissions for video-EEG monitoring of staring spells found that only about 11% of sessions captured a staring spell and confirmed it as a seizure.⁶ That does not mean the other 89% were having seizures that went unrecorded. It means that in many cases, the spells either did not occur during monitoring or turned out to be nonepileptic. The researchers developed a simple scoring system based on factors like whether the child had a normal previous EEG and whether the spells lasted under a minute. When the score was zero or lower, the chance of capturing an actual seizure dropped below 5%. Video-EEG monitoring remains a valuable tool for adjusting treatment or excluding epilepsy in children with refractory staring spells.⁷

Staring Spells Versus ADHD

One of the most common diagnostic tangles involves children whose staring spells get attributed to attention problems, or vice versa. A child who frequently zones out in class could be having absence seizures, could have ADHD (particularly the inattentive type), or could even have both. The overlap in outward appearance is real, but the underlying patterns differ in ways parents and teachers can sometimes spot.

Research comparing children with absence seizures to those with ADHD-inattentive type found that a lack of sustained attention was much more common in the ADHD group. Two specific behaviors stood out: not completing homework and not staying on task. These correctly sorted 40 out of 43 children into the right group, because children with absence seizures were rated by their parents as having low rates of these behaviors.⁸ In other words, a child with absence seizures typically does fine when the seizure is not happening. They can sustain attention, complete work, and stay on track. The blanking out is episodic and brief, not a chronic difficulty with focus. A child with ADHD, by contrast, shows persistent, day-long struggles with attention that are not confined to discrete episodes.

This distinction matters because the treatments are completely different. Stimulant medications for ADHD will not help absence seizures, and anti-seizure drugs will not help attention deficits caused by ADHD. Getting the diagnosis right saves a child from months or years of ineffective treatment.

Treatment for Epileptic Staring Spells

When staring spells are caused by absence seizures, medication is the first-line approach. The three drugs most studied for childhood absence epilepsy are ethosuximide, valproic acid (sodium valproate), and lamotrigine. A landmark trial of 453 children with newly diagnosed childhood absence epilepsy compared all three head to head. After 16 weeks, roughly half the children on ethosuximide or valproic acid were free of treatment failure, while only about 29% on lamotrigine achieved the same result.⁹ Lamotrigine was clearly less effective at controlling the seizures.

At the 12-month mark, the picture held: about 45% of the ethosuximide group and 44% of the valproic acid group were seizure-free, compared with about 21% of the lamotrigine group.¹⁰ So ethosuximide and valproic acid were roughly equal in seizure control, but they differed in side effects. Valproic acid caused more intolerable adverse events overall and was linked to more attentional problems, with about 49% of children on valproic acid showing attentional difficulties compared to 33% on ethosuximide.⁹ Given these tradeoffs, current evidence points to ethosuximide as the best starting medication for childhood absence epilepsy.¹⁰

Focal seizures that present as staring spells require a different medication strategy. Carbamazepine, phenytoin, and valproic acid are often considered first-line options, though newer drugs like lamotrigine, topiramate, and oxcarbazepine have gained approval for this use in many countries.¹¹ The choice depends on age, other medications, and whether pregnancy is a concern, since some anti-seizure drugs carry teratogenic risks.

When the Cause Is Psychological

If staring spells are psychogenic rather than epileptic, anti-seizure drugs will not help and can cause unnecessary side effects. The most studied intervention for psychogenic nonepileptic seizures is cognitive-behavioral therapy (CBT), which has been supported by randomized controlled pilot trials.¹² CBT helps people recognize and manage the psychological triggers for their episodes, whether those are anxiety, trauma responses, or other stressors.

Other therapeutic approaches have been tried, including psychodynamic therapy, mindfulness-based interventions, paradoxical intention therapy, and psychoeducation.¹³ The evidence base for these alternatives is thinner than for CBT, but in practice a therapist may combine several approaches depending on what is driving the episodes. Simply delivering the diagnosis in a clear, nonjudgmental way is itself considered a therapeutic step, because many patients improve once they understand what is happening and that the episodes are not dangerous in themselves.

How Staring Spells Affect School and Daily Life

Even when absence seizures are brief and look harmless, their cumulative effect on a child’s learning can be real. Children with absence epilepsy have been found to score lower in academic subjects compared to healthy peers.¹⁴ Part of this appears to stem from cognitive effects that are present even before treatment begins. Research has identified a chain in which attention difficulties lead to memory problems, which in turn affect executive function and ultimately academic performance.¹⁵ This means the academic struggles are not just caused by missing a few seconds of instruction during each seizure; there are broader cognitive ripple effects.

For families, this underscores the importance of getting academic support in place alongside medical treatment. About a quarter of children with childhood absence epilepsy need psychological or academic assistance during the course of their illness.¹⁶ This might include an individualized education plan, tutoring, or classroom accommodations like preferential seating and repeated instructions. Teachers who understand the condition are better positioned to distinguish a seizure from misbehavior or laziness, which reduces the social stigma the child carries.

Schools also play a practical safety role. Guidelines for school personnel emphasize the value of having a seizure emergency treatment plan on file. In cases where a child has prolonged seizures, rectal diazepam gel can be administered by trained nonmedical staff and has been shown to reduce the need for emergency department visits.¹⁷ For typical absence seizures, which end on their own in under 15 seconds, rescue medication is rarely needed, but having a plan matters for the rarer, longer events.

Long-Term Outlook

Childhood absence epilepsy has one of the more favorable prognoses among childhood epilepsies. One long-term follow-up found that about 79% of children achieved seizure remission, with treatment typically discontinued after a mean of about three years.¹⁸ Another study reported a similar remission rate of about 79%, though roughly 4% of patients experienced further seizures after stopping medication.¹⁶ A small minority of children go on to develop other seizure types, including tonic-clonic seizures in adolescence, which changes the management significantly. Doctors factor in EEG findings, age of onset, and response to initial treatment when estimating a given child’s trajectory.

For children whose staring spells were nonepileptic, the outlook depends entirely on the underlying cause. If the episodes were benign developmental phenomena like daydreaming or self-stimulatory behavior, they tend to diminish naturally with age. If they were psychogenic, the course depends on whether the child receives appropriate psychological care and whether the root stressors are addressed.

Staring Spells in Adults and Older People

Although staring spells are far more commonly discussed in children, they are not exclusively a pediatric phenomenon. Adults can develop absence seizures, sometimes as the very first manifestation of epilepsy. A case series of six patients with adult-onset absence status found that the episodes presented as prolonged confusional states rather than the brief, discrete blanking-out seen in children.¹⁹ In adults, absence status can be easily mistaken for a psychiatric condition, a drug reaction, or even early dementia.

This diagnostic confusion is particularly common in older adults, where nonconvulsive status epilepticus, a state of ongoing or recurring seizure activity without obvious convulsions, is recognized as an important and under-identified cause of sudden confusion. In the emergency department, an elderly patient who appears disoriented and unresponsive may be assumed to have had a stroke, a metabolic crisis, or a delirium from infection. Without an EEG, the seizure activity can go undetected.²⁰ The condition is reversible with appropriate treatment, which makes the missed diagnosis especially frustrating when it happens.

Driving and Other Safety Concerns

For older children and adults with epileptic staring spells, the prospect of losing driving privileges is one of the most immediate practical worries.²¹ Laws vary by state and country, but most jurisdictions require a seizure-free period, often ranging from three months to a year, before a person with epilepsy can legally drive. Even brief absence seizures, which last only seconds, can be disqualifying because a few seconds of unawareness at highway speed is enough to cause a serious crash.

Water safety is another area of concern. Swimming alone is generally discouraged for anyone with uncontrolled seizures, regardless of how mild the episodes appear. The same applies to activities where a momentary lapse of awareness could cause a fall from height or contact with dangerous equipment. These restrictions weigh heavily on adolescents and young adults in particular, and they are one reason why achieving seizure freedom through medication matters so much beyond the medical dimension.

For children whose staring spells have been confirmed as nonepileptic, these restrictions do not apply, which is one more reason why getting the diagnosis right is worth the effort. A child who goes through years of unnecessary driving restrictions because their daydreaming was misdiagnosed as epilepsy has suffered a real, avoidable harm.