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Apnoeic attacks as an isolated manifestation of epileptic seizures in infants
G P Ramelli1, F Donati, M Bianchetti
1Department of Pediatrics, University of Berne, Switzerland.
Insights
Infants can experience seizures presenting solely as apnoea (cessation of breathing). This study documents four such cases, highlighting the importance of electroencephalogram (EEG) for diagnosis and treatment in infants.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neurophysiology
Background:
- Apnoea is a recognized seizure manifestation in neonates.
- Seizure-induced apnoea is less commonly observed in infants.
Observation:
- Four infants presented with apnoea as the sole seizure symptom.
- Apnoea onset occurred between 2-11 months of age.
- Polygraphic ictal electroencephalogram (EEG) and video recording confirmed seizures.
Findings:
- Interictal EEG was normal in all cases.
- Ictal EEG revealed focal rhythmic alpha or theta activity, sometimes generalizing, lasting 40-120 seconds.
- Apnoea began shortly after rhythmic EEG activity; heart rate remained stable.
Implications:
- Highlights the diagnostic value of EEG in infant apnoea.
- Suggests prompt anti-epileptic therapy can lead to seizure freedom and normal development.
- Underscores the potential for severe developmental outcomes with untreated or refractory seizures.
Abstract:
Apnoea as an isolated manifestation of seizures is well described in neonates but is only occasionally observed in infants. We present data from four infants, with apnoea as the sole manifestation of seizures, documented by polygraphic ictal electroencephalogram (EEGC) and video recording. The four infants, after normal pregnancy and delivery at term, showed the first apnoea at the age of 2-11 months. The interictal EEG was normal. The ictal EEG and video recording showed in all infants a focal rhythmic alpha or theta activity with or without generalization, which lasted 40-120 seconds. The apnoea appeared a few seconds after the beginning of rhythmic activity and the heart rate remained unchanged during the apnoea. At 2 years' follow-up, three children are seizure-free under anti-epileptic therapy with normal psychomotor development in two, and a slight delay in the third infant. The fourth child has partial seizures and is severely retarded.