A 6 year old boy is brought to your office with history of staring spells. He has had three such episodes in the past one month. His mother reports that during the episode he stares blankly in to space for about two to three minutes. He does not respond to verbal commands during such episodes. The episodes are usually, followed by a period during which he is either confused or drowsy for about 30 minutes. On two such occasions, he reported unpleasant taste sensation prior to the staring spells. On examination, he appears comfortable and healthy. There are no physical abnormalities. Basic laboratory investigations including thyroid stimulating hormone are normal. Which of the following is the most appropriate diagnosis?
A) Attention Deficit Hyperactivity Disorder
B) Absence Seizures
C) Complex Partial Seizures
D) Simple Partial Seizures
E) Generalized Seizures
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[sociallocker]The differential diagnosis of Staring spells in children include Absence Seizures, Complex partial seizures and Non Epileptic Staring spells (Day-Dreaming, Inattention spells) The patient has complex partial seizures as evidenced by loss of consciousness during the episode and preceded by aura and followed by postictal state. Symptoms of Complex partial seizures vary massively among the patients. When starting spells are the only manifestation of complex partial seizures, it is important not to get confused with Absence Seizures. Absence seizures are a type of generalized seizures – hence, they are not preceded by Aura and there is no postictal state. Also, Absence seizures are very brief lasting only for few seconds (15 to 30 seconds) unlike complex partial seizures that may last several minute. These features will help differentiate a “True” absence seizure from a complex partial seizure.[/sociallocker]