Tonic reflex seizures of early infancy: an age-related non-epileptic paroxysmal disorder

Area of Science:

• Neurology
• Pediatrics
• Neonatology

Background:

• Non-epileptic paroxysmal disorders (NEPD) present diagnostic challenges, often mimicking epileptic seizures in infants.
• Unusual movements are common in early-life NEPD, particularly within the first year.

Purpose of the Study:

• To describe the clinical and EEG-polygraphic features of a novel NEPD observed in infants.
• To characterize non-epileptic tonic reflex seizures of early infancy (TRSEI) and propose its classification.

Main Methods:

• Observational study of 13 infants (9 male, 4 female) presenting with NEPD between 1988 and 1999.
• Detailed clinical assessment, including seizure semiology, developmental milestones, and neurological examination.
• Electroencephalography (EEG) and polygraphy during ictal and interictal periods.

Main Results:

• Identified 13 infants with TRSEI, manifesting between 1-3 months of life, with normal psychomotor development and no neurological history.
• Seizures involved diffuse tonic contraction, limb extension, apnea, and cyanosis (3-10 sec duration), triggered by tactile stimulation or movement in a vertical position while awake.
• Normal ictal and interictal EEG findings were consistently observed.

Conclusions:

• TRSEI is a distinct, new NEPD presenting in early infancy, characterized by specific triggers and benign clinical course.
• The condition exhibits a benign prognosis with spontaneous remission typically occurring within two months of onset.
• TRSEI should be differentiated from epileptic seizures due to its unique presentation and favorable outcome.