Paroxysmal non‐epileptic events in infants and toddlers: A phenomenologic analysis

Abstract

Aim:The aim of this study was to analyze in detail the clinical phenomenology of paroxysmal nonepileptic events (PNEE) in infants and toddlers. Methods:We studied all children aged ≤2 years who were diagnosed with PNEE based on videoelectroencephalographic (VEEG) recordings. We analyzed the following four clinical domains of each clinical event: (i) motor manifestations (body/limb jerking, complex motor, and asymmetric limb posturing); (ii) oral/vocal (crying, vocalization, sighing); (iii) behavioral change (arrest of activity, staring); (iv) and autonomic (facial flushing, breath holding).Results: Thirty-one of 81 (38.3%) infants and toddlers had 38 PNEE recorded during the study period (12 girls and 19 boys, mean age 10.5 months). The predominant clinical features were as follows: motor in 26/38 events, oral/verbal in 14/38 events, behavioral in 11/38 events, and autonomic in 8/38 events. Epileptic seizures and PNEE coexisted in four children (12.9%). Seventeen children (54.8%) had one or more risk factors suggestive of epilepsy. Twelve children (38.7%) had a normal neurologic examination, 10 (32.3%) had developmental delay, and eight (25.8%) had a family history of epilepsy or seizures.Conclusion: VEEG recorded PNEE in nearly 40% of 81 infants and toddlers referred for unclear paroxysmal events in our cohort. Non-epileptic staring spells and benign sleep myoclonus were the most common events recorded, followed by shuddering attacks and infantile masturbation. In addition, greater than onehalf of the infants and toddlers had risk factors, raising a concern for epilepsy in the family and prompting the VEEG evaluation, suggesting that paroxysmal non-epileptic seizures may frequently coexist in young children with epilepsy.

Paroxysmal nonepileptic events in pediatric patients

“…Physiological nonepileptic events differ from psychogenic nonepileptic seizures in many aspects including the age of symptom onset. Chen et al [5] noted that physiologic disorders including staring, sleep myoclonus, shuddering, and behavioral events comprise the majority of PNEs in infants and toddlers. On the other hand, Luat et al [6] found that psychogenic nonepileptic seizures tend to occur more frequently in school-age children and adolescents.…”

Brain metabolite values in children with breath-holding spells

“…The breath-holding spells were classified as mild, moderate, and severe (Table 1). Patients were excluded from the study with spells associated with metabolic problems, electrolyte disturbances, and trauma to avoid including children with seizures that can mimic breath-holding spells 17,18. In addition, a total of 12 patients were excluded from the study due to hypocalcemia-related tremor (2), early childhood benign myoclonus (4), hyperekplexia (2), benign infantile epilepsy (3), and benign paroxysmal vertigo (1).…”

Semiological Features of Nonepileptic Paroxysmal Events in Infancy

“…According to Visser et al [3], the incidence of paroxysmal disorders in infancy is 8.9%, of which 52% are physiological events. tion, and alleviating parents' worries [2,[5][6][7]. Diagnosis can usually be made based on detailed history and examination, with the knowledge of several types of NPEs with distinctive clinical presentations [5,7].…”

“…tion, and alleviating parents' worries [2,[5][6][7]. Diagnosis can usually be made based on detailed history and examination, with the knowledge of several types of NPEs with distinctive clinical presentations [5,7]. However, differentiation between true seizures and NPEs is difficult during infancy due to variations in semiology and incorrect history provided by parents or caregivers.…”

“…Because of these difficulties, video electroencephalographic (VEEG) recording is required for a definitive diagnosis [6,8]. Although VEEG recording is the most accurate diagnostic method, it is difficult to perform in infants, and cannot easily be performed in all medical centers [5]. Due to widely available smartphones, mobile phone video can be used as an important diagnostic tool before proceeding to VEEG recording.…”