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Apparent life-threatening episodes as the first manifestation of epilepsy

Magda Lahorgue Nunes1, Carla Calcagnoto Appel, Jaderson Costa da Costa

  • 1Divisions of Neurology, Hospital São Lucas, PUCRS School of Medicine, Porto Alegre, RS, Brazil.

Clinical Pediatrics
|March 15, 2003
PubMed

Insights

Apparent life-threatening episodes (ALTE) in children may signal underlying epilepsy. Early diagnosis is often delayed, but ictal EEG and brain imaging can confirm epileptic seizures presenting as ALTE.

Area of Science:

  • Pediatric Neurology
  • Epileptology
  • Clinical Neurophysiology

Background:

  • Apparent life-threatening episodes (ALTE) are a diagnostic challenge in pediatrics.
  • Epilepsy can present initially as ALTE, complicating diagnosis.
  • Gastroesophageal reflux is a common differential diagnosis that can obscure epileptic manifestations.

Observation:

  • This study retrospectively analyzed 6 pediatric cases where ALTE was the first seizure manifestation.
  • Interictal electroencephalogram (EEG) findings were often normal, delaying diagnosis.
  • Abnormal cerebral imaging was noted in some patients.

Findings:

  • Ictal EEG recordings were the most effective diagnostic tool for confirming epileptic seizures presenting as ALTE.
  • In cases with only interictal EEGs, abnormal cerebral imaging provided valuable diagnostic support.
  • Prompt recognition of epilepsy is crucial for appropriate management.

Implications:

  • Highlights the importance of considering epilepsy in children with ALTE.
  • Emphasizes the diagnostic utility of ictal EEG and neuroimaging in these complex cases.
  • Suggests improved diagnostic pathways to reduce delays in epilepsy diagnosis for children presenting with ALTE.

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