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Video EEG analysis of non-ictal events in children
Insights
Telemetry monitoring revealed that many childhood events initially suspected as seizures were non-ictal. Accurate diagnosis requires specific identification or descriptive analysis, not the term 'pseudoseizure'.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Many childhood events are referred for suspected seizures.
- Distinguishing non-ictal events from epilepsy is crucial for accurate diagnosis and management.
Purpose of the Study:
- To analyze the nature of childhood events initially suspected as seizures.
- To evaluate the utility of prolonged video and electroencephalogram (EEG) monitoring (telemetry) in diagnosing these events.
- To advocate for specific diagnoses or descriptive patterns over the term 'pseudoseizure'.
Main Methods:
- A 3-year study involving 186 children (3 weeks to 17 years) undergoing telemetry at a children's hospital.
- Clinical analysis and prolonged video and EEG monitoring were used to assess referred events.
- Categorization of events into specific diagnoses or descriptive patterns.
Main Results:
- Of 74 referred events initially suspected as seizures, telemetry confirmed 74 as non-ictal.
- Specific diagnoses were reached for 24 events, including spasticity, Münchausen-by-proxy, breathholding, and movement disorders.
- The remaining 51 events were described by patterns such as staring, jerks, or unusual behavior.
- Electroencephalogram (EEG) findings varied, with normal EEGs in 49 cases, abnormal background rhythms in 7, and epileptiform activity in 19.
Conclusions:
- Telemetry is valuable in differentiating non-ictal events from seizures in children.
- The term 'pseudoseizure' should be avoided; specific diagnoses or descriptive analyses are preferred.
- The diverse range of childhood behaviors necessitates precise diagnostic approaches, often requiring telemetry.
Abstract:
Over a 3 year period 186 children aged 3 weeks to 17 years were studied by telemetry (prolonged video and EEG monitoring) at the Prince of Wales Children's Hospital: 74 had events considered at referral to possibly represent seizures but which were shown by clinical analysis and telemetry to be non-ictal. Nine such patients were developmentally delayed, one was neurologically impaired and 16 were both developmentally delayed and neurologically impaired. A specific diagnosis of the non-ictal events was reached in 24 subjects-postures of spasticity in children with neurological impairment (6), Münchausen-by-proxy (5), pseudoseizures (3), breathholding (2), masturbation (2), reflux (2), shudder (1), movement disorder (1), motor tic (1) and pertussis (1). Specific descriptive patterns were assigned to the remaining 51 events. These included staring (20) and jerks (16) or unusual behaviour (15). 49 inter-event EEGs were normal; 7 displayed abnormal background rhythms and 19 showed epileptiform activity. We discourage use of the term 'pseudoseizure' for the majority of the events described and prefer that a specific diagnosis be made or a descriptive analysis be provided. The events seen illustrate the wide spectrum of childhood behaviour and on occasions suggest the need for telemetry to determine their true nature.