ABSTRACT. Objective. Paroxysmal events are frequent in infancy. A precise diagnosis is often difficult to assign despite adequate history and physical examination. Certain clinical signs may help to suggest the diagnosis, thereby avoiding unnecessary and costly investigations. The aim of this study was to determine the frequency of eye opening during infantile seizures and evaluate the potential usefulness of this simple observation in the differential diagnosis of acute events in infants.Methods. We performed a retrospective video electroencephalogram review of the seizures recorded in infants at our Epilepsy Center, paying specific attention to eye opening.Results. I nfants (children aged 1-24 months) can have a variety of peculiar paroxysmal events. 1,2 Most confusing can be the infant who suddenly has altered behavior or a dramatic fluctuation in the level of alertness for no clear reason. A variety of causes are often suspected, including syncope and epilepsy. Although it is clear that an accurate differential diagnosis depends on careful attention to the history, some simple features may be of use. During a recent presentation at the daily pediatric intake rounds, a resident observed that an infant's eyes were closed throughout the paroxysmal event. This struck us as unusual for an ictal event, so we carefully examined our experience with video electroencephalogram (EEG) recordings of infants with seizures to determine how often eyes were closed throughout recorded events.
METHODSThe database of the Epilepsy Center at Children's Memorial Hospital (Chicago, IL) includes patients who are aged 1 day to 18 years and present with a great diversity of indications, ranging from new-onset paroxysmal spells to intractable epileptic seizures. Twenty-three gold electrodes are used for all recordings, including 3 references and the ground, and placed according to the rules of the 10 -20 international system. All recordings are interpreted by a pediatric epileptologist at Children's Memorial Hospital.The seizures and the epilepsy syndromes were classified according to the International League Against Epilepsy recommendations, 3,4 as described in Table 1. To increase the accuracy of the classification, we created a subcategory of partial seizures (2.4) for which it was impossible to determine alteration of consciousness or secondary generalization and further specified the event type by adding its predominant clinical manifestation.From a total of 2112 patients monitored in our video EEG laboratory from May 2000 through January 2005, 109 distinct seizures in 77 infants were analyzed. When several seizures were recorded during the same EEG, only 1 seizure type per EEG was considered (eg, if 100 spasms and 50 clonic seizures were noted during the same recording, then only 1 of each was considered; if spasms or clonic seizures were recorded during another EEG, then 1 event per seizure type was considered as well). The entire video file was reviewed throughout the ictus. Nonepileptic events were not analyzed for comparison ...