Non-convulsive (nonepileptic) paroxysmal disorders in newborns and infants

Paroxysmal non-convulsive (non-epileptic) disorders are common in the paediatric population (estimated at 10%). Up to 25% of children with normal psyhomotor development and even 60% of infants referred for paroxysmal disorders have nonepileptic events. These conditions are clinical disorders of usually sudden appearance, brief, often recurrent and can be followed by or without loss of consciousness. Non-epileptic events originate from a cerebral disfunction of diverse causes but never from paroxysmal brain cortical electrical activity like in epilepsy. In newborns and infants they include paroxysmal anoxic-ischemic disorders (cyanotic and pallid breath-holding spells), attacks occurring during sleep (benign neonatal sleep myoclonus), spells with stereotypical movements and postures (benign non-epileptic infantile spasms, benign paroxysmal torticolis, hyperekplexia, head rocking, shuddering attacks) sometimes of normal physiological human behaviour (self gratification or masturbation). The course of non-epileptic events is usually good, but some of them can be followed by serious complications and sudden infant death (major hyperekplexia in neonate, for example). The differentiation between non-epileptic and epileptic paroxysmal events can be difficult particularly in neonatal and infant period. Age, the clinical characteristics of non-epileptic events and normal results of testing (video EEG-monitoring is a diagnostic procedure of choice) are important factors in differential diagnosis. Electroencephalograms (both during attacks and between them) are normal. The serious mistake of misdiagnosing a non-epileptic disorder as an epileptic seizure could lead to parental anwiety, while the child is unnecessarily exposed to the potentially toxic anti-epileptic drugs.
Keywords: SEIZURES – diagnosis; EPILEPSY – diagnosis; DIAGNOSIS, DIFFERENTIAL; SPASMS, INFANTILE – diagnosis; MOVEMENT DISORDERS - diagnosis
Category: Review
Volume: Vol. 51, No 4, october - december 2007
Authors: Z. Sabol
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