Apparent life-threatening events: neurological correlates and the mandatory work-up
Jacob Genizi1, Giora Pillar, Sarit Ravid
1Child Neurology Unit & Epilepsy Service, Meyer Childrens Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa 31096, Israel.
Insights
Neurological causes for apparent life-threatening events (ALTEs) in infants are uncommon, with seizures being the most frequent neurological etiology. Diagnostic approaches should prioritize clinical evaluation over extensive testing.
Area of Science:
- Pediatric Neurology
- Neonatology
- Critical Care Medicine
Background:
- Apparent life-threatening events (ALTEs) in infants present a diagnostic challenge.
- Neurological disorders are hypothesized as a common cause of ALTEs.
Purpose of the Study:
- To determine the prevalence of neurological causes for ALTEs in infants.
- To evaluate the necessary neurological work-up for diagnosing these conditions.
Main Methods:
- Retrospective chart review of 93 infants meeting NIH criteria for ALTEs.
- Infants aged 1 week to 8 months presenting with apnea, color changes, unresponsiveness, and altered tone were included.
Main Results:
- A neurological etiology was identified in 18% of infants (15 with seizures, 3 with central apnea).
- Electroencephalography (EEG) showed epileptic discharges in only one infant.
- Brain imaging was normal in all cases.
Conclusions:
- Neurological impairment, particularly seizures, is an uncommon cause of ALTEs in infants.
- Clinical history and physical examination are the primary diagnostic tools.
- Extensive laboratory studies may not be routinely necessary.
Abstract:
The purpose of this study was to estimate the prevalence of neurological causes for apparent life-threatening events in infants and assess the neurological work-up mandatory to diagnose such diagnosis, hypothesizing that acute neurological disorders constitute the most common etiology for such an acute event. A retrospective chart review allocated 93 infants fulfilling the criteria of the National Institutes of Health presenting at 1 week to 8 months with apnea, color changes, gagging, unresponsiveness, and alterations of body tone. An underlying neurological etiology was detected in 18 (19%), whereby 15 had seizures and 3 had central apnea. Only one electroencephalography demonstrated epileptic discharges, and brain imaging was intact. Thus, it has been concluded that neurological impairment, mainly that of seizures inducing an apparent life-threatening event, are relatively uncommon. As such, recommendations are that history taking and repeat physical examination still remain the major diagnostic tools before resorting to extensive laboratory studies.
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