Non epileptic paroxysmal events in childhood

Abstract

Non epileptic paroxysmal events are recurrent movement disorders with acute onset and ending, which may mimic epilepsy. The duration, place, timing of the attacks, and state of conciousness may confuse pediatricians about the diagnosis of epilepsy and non epileptic paroxysmal events. The key point in the diagnosis is taking an accurate and detailed history. Wrong diagnosis can give rise to anxiety of both the family and the child, interruptions in the child's education, limitations in career planning, and irreversible damages in the long term. The diagnosis can prevent unnecessary drug use and psychological damage. This review aims to discuss the clinical findings, treatment, and differential diagnoses of non epileptic paroxysmal events, and to increase awareness about non epileptic paroxysmal events among pediatricians. (Turk Pediatri Ars 2017; 52: 59-65)

Neuroglobin and Prolactin As Potential Biomarkers for Differentiating Epileptic versus Nonepileptic Paroxysmal Disorders in Children

“…The duration, timing of the attacks, and state of consciousness may confuse pediatricians about the diagnosis of epilepsy and nonepileptic paroxysmal events. 3 Multiple nonepileptic paroxysmal conditions can occur in childhood as breath-holding spells, sleep disorders, shuddering attacks, syncope, benign paroxysmal torticollis, and psychogenic crises.…”

“…Antiepileptic drugs may sometimes increase sleep myoclonus. 3 A breath-holding attack (BHA) is a benign paroxysmal nonepileptic disorder occurring in healthy children 6 to 48 months of age. The attack starts with a provocation such as emotional upset, and might progress to breath holding, cyanosis, and syncope.…”

“…It can be misdiagnosed as generalized tonic-clonic seizure, focal seizures, absence seizures, and drop attacks. 3 Night terror (NT) is characterized by screaming, cold sweat, hallucinations and it occurs approximately 1.5 to 2 hours after falling asleep. It typically occurs once a night.…”

“…A wrong diagnosis may cause the child to change lifestyle, career plans, and choice of profession, which is a cause of anxiety for both the child and family in long term. 3 Missed diagnosis of epileptic seizures has more consequences than those of nonepileptic seizures. Children with epilepsy carry significant safety concerns including accidents caused by seizures, death directly resulting from status epilepticus or severe seizures, and sudden unexpected death in epilepsy.…”

“…1,2 An accurate and detailed history and images from ordinary devices such as smart phones and cameras help to differentiate between these conditions. 3 There is still no single investigation to confirm the diagnosis. Long-term video-electroencephalography (EEG) monitoring, is the most important test but not available in all centers.…”