In a cohort of 59 consecutive children referred for staring spells, we analysed clinical and electroencephalogram (EEG) characteristics in 23 children with both a history of absence seizures and a generalized spike and wave pattern during long-term video EEG monitoring. In 10 children, a frontal spike preceded the generalized spike and wave pattern. In the remaining 13 children, primary generalized spikes and waves were found. The frontal onset absences were clinically not different from primary generalized absences. The most striking difference between the two groups was the difficulty in controlling the absences in the frontal onset group and the high incidence of learning and behavioural problems in that group. The EEG analysis showed interictal, isolated epileptic discharges in 80% of the children with frontal onset absences. We believe that frontal onset absences should be considered as a secondarily generalized epilepsy syndrome, originating in the frontal regions.