An 8-year-old boy is referred by his teacher for poor attention, daydreaming, and falling grades. On careful history, the mother describes brief episodes lasting about 10 seconds during which he stops activity mid-task, stares blankly, and then resumes exactly where he left off, occurring dozens of times daily. There are no motor symptoms. What is the next best step?

• A Start methylphenidate empirically and review response
• B Serum thyroid function tests
• C Brain MRI to rule out a structural lesion
• D Electroencephalogram to look for generalized 3 Hz spike-and-wave discharges ✓

Explanation

The abrupt, very brief, frequent staring spells with immediate resumption and no response to name during the episode suggest childhood absence epilepsy, which is routinely mistaken for ADHD inattentive presentation. The diagnostic test is EEG showing generalized 3 per second spike-and-wave bursts, often provoked by hyperventilation. Giving a stimulant without excluding absence seizures risks masking the diagnosis, and MRI and thyroid tests do not address the likely cause.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.