Episodic symptoms mistaken for seizures in the neurologically impaired child

Donat, Jane F.; Wright, Francis S.

doi:10.1212/wnl.40.1.156

Cited by 47 publications

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“…1 In children, besides psychogenic seizures, physiologic and organic disorders also mimic seizures [2][3][4][5][6] ; on the other hand, psychogenic seizures and cardiac events comprise the largest categories among adults. [7][8][9][10][11][12][13][14] Although the presentation of specific disorders has been described in detail, the literature contains only scant data concerning the relative frequency of various types of PNEs in children and adolescents. Recently, Bye et al 15 reported that PNEs accounted for 43% of children who underwent video-electroencephalographic (EEG) monitoring.…”

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confidence: 99%

Paroxysmal Nonepileptic Events in Children and Adolescents

et al. 2002

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ABSTRACT. Objective. Paroxysmal nonepileptic events (PNEs) are frequently encountered in children and adolescents; however, there is little information concerning the relative frequency of various types of these disorders. We report our experience with PNEs in a group of children and adolescents who underwent prolonged video-electroencephalographic monitoring.Methods. During a 6-year period, 883 patients were monitored in the Pediatric Epilepsy Monitoring Unit and 134 patients (15.2%) were documented to have PNEs on the basis of a typical spell recorded during monitoring. Their hospital charts were reviewed and videotapes of these events were analyzed.Results. Patients were divided into 3 age groups: 1) the Infant, Toddler, and Preschool Group (2 months-5 years) that comprised 26 patients. The most common diagnoses were stereotyped movements, hypnic jerks, parasomnias, and Sandifer syndrome. Concomitant epilepsy was present in 12 patients (46%). 2) The School-Age Group (5-12 years) consisted of 61 patients. The most frequent diagnoses were conversion disorder (psychogenic seizures), inattention or daydreaming, stereotyped movements, hypnic jerks, and paroxysmal movement disorders. Fifteen patients (25%) had concomitant epilepsy. 3) The Adolescent Group (12-18 years) consisted of 48 patients, of whom 40 patients (83%) were diagnosed with conversion disorder. Nine patients (19%) had concomitant epilepsy.Conclusions. In our patients with PNEs, conversion disorder was seen in children >5 years old and its frequency increased with age, becoming the most common type of PNEs among adolescents. In adolescents, conversion disorder was more common in females, whereas males predominated in the school-aged group. Concomitant epilepsy with nonepileptic events occurred in all 3 age groups to a varying extent. Pediatrics 2002;110(4). URL: http://www.pediatrics.org/cgi/content/full/110/4/ e46; nonepileptic, paroxysmal, psychogenic seizures, children, adolescents.

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Paroxysmal Nonepileptic Events in Children and Adolescents

et al. 2002

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“…Non-epileptic events (see Table IV) in children with MR were usually diagnosed as behavioral or physiological, as were such events recorded in children under the age of 5 years. Other authors (Neill and Alvarez 1986, Donat and Wright 1990, Desai and Talwar 1992 blinking, shuddering, myoclonus, startle, and abnormal posturing with screaming and tremulousness. In older children without MR, non-epileptic events included staring and unresponsiveness, tonic and clonic jerking (pseudoseizures), pelvic thrusting, and heavy breathing.…”

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confidence: 99%

“…Video-EEG has been available in most tertiary care centers in the US for the last 20 years, and its value in the diagnosis of paroxysmal events in childhood has been established (Holmes et al 1980, Duchowny et al 1988, Rothner 1989, Donat and Wright 1990, Desai and Talwar 1992, Connolly et al 1994, Foley et al1995, Carmant et al 1996. From these studies it would appear that history, observation, and interictal EEG are not a substitute for video-EEG recordings in the differentiation of epileptic from non-epileptic events.…”

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“…From these studies it would appear that history, observation, and interictal EEG are not a substitute for video-EEG recordings in the differentiation of epileptic from non-epileptic events. Some series have included small numbers of children with MR (Duchowny et al 1988, Donat and Wright 1990, Desai and Talwar 1992, Foley et al1995, Carmant et al 1996 and one studied a large number of adults with MR (Neill and Alvarez 1986). However, no published studies have specifically examined the utility of video-EEG in the diagnosis of epilepsy and non-epileptic events in children with and without MR.…”

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Video‐EEG in the diagnosis of paroxysmal events in children with mental retardation and in children with normal intelligence

Thirumalai

Abou‐Khalil

Fakhoury

et al. 2001

Develop Med Child Neuro

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Video‐EEG monitoring was performed to evaluate 193 children (91 females, 102 males; mean age 9.6 years, SD 5.7) who presented with paroxysmal events of uncertain etiology. Diagnosis of the type of event, i.e. epileptic or non‐epileptic, was successfully established in 130 of 193 patients (67.3%). Seventy children (36%) had mental retardation (MR). Children with MR were more likely (p<0.05) than children without MR to have events during the studies. Children with and without MR had strikingly similar frequencies of epileptic and non‐epileptic events. In participants who had events recorded and characterized, epileptic seizures were identified in 67 children (51.5%), non‐epileptic events in 54 children (41.5%), and both epileptic and non‐epileptic events in nine children (7%). Improved diagnosis prompted appropriate management. This should encourage more frequent use of video‐EEG in children, especially in those with MR, to differentiate epilepsy from behavioral disturbances so that specific treatment can be provided.

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“…Scalp EEG recording may not always detect ictal changes during seizures that do not affect consciousness (partial simple seizures), but ictal changes are usually detectable during seizures that do affect consciousness (partial complex and generalized seizures). EEG recording during behavioral events believed to be seizures in individuals with mental retardation has shown that approximately 40% of such behavioral events do not meet the definition and are not really seizures (14)(15)(16). Other causes for these seizure-like behaviors include psychiatric disorders, muscle spasms (particularly in persons with cerebral palsy), paroxysmal movement disorders (such as tics, choreoathetosis, or dystonia), vasovagal or cardiac syncope, sleep disorders (such as narcolepsy or cataplexy), and migraine.…”

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confidence: 99%

Comprehensive Management of Epilepsy in Persons with Mental Retardation

Coulter

1997

Epilepsia

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Summary: Epilepsy is a common occurrence in persons with mental retardation. The application of recent advances in epilepsy research to patients with mental retardation has shown that well‐accepted principles of management are as relevant for multiply handicapped people as for those with epilepsy alone. Quality enhancement is emphasized as the overarching concept that determines the quality of care provided to patients with epilepsy and mental retardation. This article reviews the comprehensive management of epilepsy, discusses what is known at present, and indicates what is not known and needs further research.

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Episodic symptoms mistaken for seizures in the neurologically impaired child

Cited by 47 publications

References 0 publications

Paroxysmal Nonepileptic Events in Children and Adolescents

Paroxysmal Nonepileptic Events in Children and Adolescents

Video‐EEG in the diagnosis of paroxysmal events in children with mental retardation and in children with normal intelligence

Comprehensive Management of Epilepsy in Persons with Mental Retardation

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