Question of the Week # 356

356) A 7 year old boy is evaluated in your office for frequent episodes of “staring spells” while at school. His teacher reports that he does not seem to concentrate during the class and stares blankly in to space. He has had many such episodes in the past six months that got his teacher very concerned. Waving a hand in front of his eyes and calling out his name does not seem to disrupt these episodes. Often he returns to his norm when the boy next to him physically moves him or tickles him. He is otherwise, healthy and plays well with other kids without any issues. His mother also has noticed such episodes while he was watching television at home. On examination, he appears comfortable and healthy. There are no physical abnormalities.  He is attentive to your questions and does not seem to be distracted. Which of the following is the most appropriate next step?

A) Re-assurance

B) Obtain Electro-Encephalogram

C) Refer to Child Psychiatry

D) Start Methylphenidate trial

E) Refer to Neurology

12 Responses

  1. B) Obtain Electro-Encephalogram – shows 3 sec spike and slow wave discharges

  2. B

  3. B) Obtain Electro- Encephalogram

  4. neurology reference

  5. b

  6. Refer the child to neurologist for the further evaluation

  7. What is a testing by tickling? Have your ever day-dreamed as a child? How will you differentiate Day-dreaming from Absence seizures? This will clarify the answer to this question

  8. i would go with reassurance. Because this boy does not have post ictal confusion to call it absence seizure. So no need of EEG. He must be just day dreaming.

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