Fifteen-minute consultation: when is a seizure not a seizure? Part 2, the older child

Babiker, Mohamed OE; Prasad, Manish

doi:10.1136/archdischild-2015-308343

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…History alone was sufficient for diagnosis in 50% cases reiterating its value. [ 14 15 ] However, VEEG was employed in 18.4% patients and was long enough (few hours-six days) to capture at least one habitual event. Suggestibility was used for psychogenic seizures.…”

Section: Discussionmentioning

confidence: 99%

“…Classic features of psychogenic events leading to diagnosis were bizarre tremor-like movements, side to side head or body movements, prolonged attacks with eyes closed and resistance to eye opening, lack of injuries and precipitation with verbal suggestions and audience. [ 4 5 , 11 12 13 14 15 ] The EEG remained normal during these episodes.…”

Section: R Esultsmentioning

confidence: 95%

“…[ 10 ] The most helpful way to differentiate PNE from seizure is a detailed history and eye-witness description of the event augmented by an event video. [ 14 15 ] Certain clinical cues clinch the diagnoses. VEEG is the gold standard for confirmation though high cost, availability and expert interpretation limits its use.…”

Section: Introductionmentioning

confidence: 99%

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Paroxysmal nonepileptic events in a pediatric epilepsy clinic

et al. 2021

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A BSTRACT Aims: We aimed to study the frequency, age, and gender distribution of paroxysmal nonepileptic events (PNEs) in children referred to epilepsy clinic with the diagnosis of epilepsy. We also evaluated the therapeutic implications of correct diagnosis and co-existence of true epilepsy in this population. Settings and Design: All new patients below 18 years attending the Pediatric epilepsy out-patient clinic of PD Hinduja hospital over 6 months were evaluated. Materials and Methods: Patients with history of paroxysmal events characterized by abrupt changes in consciousness or behavior or movement were included. They were assessed on description of events aided by recorded videos. If the diagnosis was not confirmed by this preliminary evaluation, further investigations were advised. Statistical Analysis Used: Chi-square/Fisher’s exact test was used to analyze differences between categorical variables and Kruskal–Wallis test between continuous variables. The data were analyzed by SAS University Edition. All significance tests were two-tailed with α <0.05. Results: Two hundred new patients presenting with paroxysmal events were enrolled over 6 months. After diagnoses, 19% of these children had PNEs, 80% had epileptic events, and 1% remained undiagnosed. Common nonepileptic events seen were physiological in patients below 5 years and psychogenic in older children. Thirty-four percent of patients with PNEs were on anti-epileptic drugs (AEDs). After confirming nonepileptic attacks, only 2.6% patients needed AEDs for coexisting epilepsy which was statistically significant ( P < 0.001) change in treatment. Conclusions: Epilepsy mimics are common in children and are often misdiagnosed causing undue stress. Correct diagnosis leads to a drastic change in management like withdrawal of drugs, commencing new treatment if needed, and appropriate referrals.

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Section: Discussionmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 95%

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Paroxysmal nonepileptic events in a pediatric epilepsy clinic

et al. 2021

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“…

Non-epileptic paroxysmal motor events (NEPMs) are episodes of paroxysmal changes including behavior, sensation, or consciousness that lead to repeated, intermittent, and unusual movements within the same context [1][2][3]. Since it is difficult to differentiate

…”

mentioning

confidence: 99%

Development of a Risk Predictive Scoring System for Epilepsy in Infants with Paroxysmal Motor Events: A Retrospective Single-Center Study

et al. 2021

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Purpose: Paroxysmal motor events are common clinical symptoms in infants visiting pediatric neurology clinics. Due to the heterogeneous clinical symptoms and the difficulty of interpreting electroencephalography (EEG) in infants, differentiating paroxysmal motor events from epileptic events is challenging. This study aimed to investigate the risk factors for the diagnosis of epilepsy in infants and to develop a scoring system that predicts the risk of epilepsy.Methods: We retrospectively analyzed data from patients who presented with paroxysmal motor events in infancy between January 2008 and December 2009 at Asan Medical Center. Electronic medical records were reviewed for patients’ demographics, medical history, clinical characteristics associated with specific situations, and motor symptoms. Laboratory findings, EEG, and brain magnetic resonance imaging were also reviewed. Results: In total, 111 infants with paroxysmal motor events were enrolled. Non-epileptic paroxysmal motor events (NEPMs) were associated with specific situations (P<0.001). Patients with epilepsy were likely to have focal motor symptoms (P=0.08), a medical history of a neurologic disorder, and/or a family history of epilepsy (P<0.05). A risk scoring system was developed based on these risk factors; using this system, infants with 2 or more points could be diagnosed with epilepsy with 61.76% sensitivity and 88.31% specificity.Conclusion: Infants with paroxysmal motor events were more likely to be diagnosed with NEPMs than with epilepsy. An absence of specific situations for paroxysmal events, focal motor seizures, and a medical history of another illness were associated with the final diagnosis of epilepsy.

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“…A seizure is an observable abrupt paroxysmal change in behaviour or consciousness and can occur due to various causes, including epileptic, syncope and functional 6. An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain 6. The classification of epileptic seizures has recently been revised 7…”

Section: The Diagnosis Of Epilepsymentioning

confidence: 99%

Fifteen-minute consultation: When medicines don’t work—the child with poorly controlled seizures

Harijan

Seal

Prasad

et al. 2018

Arch Dis Child Educ Pract Ed

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Drug-resistant epilepsy (DRE) occurs in 20%–30% of children with epilepsy with significant impact on their quality of life. Management of this group of children has greatly improved in the recent years with streamlining of epilepsy surgery services and associated quaternary multimodal evaluation. This article provides a review of DRE in children and management based on recent evidence and published opinion. We have also presented an algorithmic approach to the child with possible DRE.

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Fifteen-minute consultation: when is a seizure not a seizure? Part 2, the older child

Cited by 7 publications

References 11 publications

Paroxysmal nonepileptic events in a pediatric epilepsy clinic

Paroxysmal nonepileptic events in a pediatric epilepsy clinic

Development of a Risk Predictive Scoring System for Epilepsy in Infants with Paroxysmal Motor Events: A Retrospective Single-Center Study

Fifteen-minute consultation: When medicines don’t work—the child with poorly controlled seizures

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