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'Not everything that shakes is epilepsy'. The differential diagnosis of paroxysmal nonepileptiform disorders
Insights
Pediatricians should carefully evaluate unusual spells in children. Misdiagnosing spells as epilepsy can be avoided with thorough history, examinations, and diagnostic tests like video-EEG monitoring.
Area of Science:
- Pediatric Neurology
- Childhood Neurological Disorders
Background:
- Infants, children, and adolescents frequently present with unusual mannerisms and behaviors.
- These spells can cause parental concern and lead to medical consultations.
- Distinguishing benign spells from epilepsy is crucial for appropriate management.
Purpose of the Study:
- To review common spells in pediatric patients that are often misdiagnosed as epilepsy.
- To emphasize the importance of accurate diagnosis in pediatric neurological conditions.
- To guide clinicians in evaluating and managing non-epileptic events in children.
Main Methods:
- Review of common pediatric spells that mimic epilepsy.
- Emphasis on detailed patient history and comprehensive physical/neurological examinations.
- Discussion of diagnostic tools including cardiac evaluation, video-electroencephalography (EEG) monitoring, and polysomnography.
Main Results:
- Thorough evaluation and diagnostic testing can lead to specific diagnoses in many cases.
- Even without a definitive diagnosis, reassurance and follow-up are beneficial.
- Accurate differentiation from epilepsy prevents unnecessary anti-epileptic drug treatment.
Conclusions:
- A systematic approach involving history, examination, and targeted investigations is essential for diagnosing pediatric spells.
- Careful evaluation helps avoid misdiagnosis of epilepsy, ensuring appropriate care.
- Management strategies should be tailored to the specific diagnosis or lack thereof, prioritizing patient and family support.
Abstract:
Many infants, children, and adolescents exhibit unusual mannerisms, behaviors, and spells. These events cause concern to parents and are frequently brought to the attention of physicians. If the spells are infrequent and do not interfere with function, no intervention may be necessary. If they are severe and recurrent, however, diagnostic evaluation is necessary. This article has reviewed the most common spells that can be misdiagnosed as epilepsy by pediatricians. Other spells such as head banging, head rolling, body rocking, enuresis, nightmares, bruxism, obsessions, compulsions, self-injurious behavior, self-stimulating behavior, and stereotypies are reviewed elsewhere. Emphasis is placed on the importance of a thorough history, a complete general physical and neurologic examination, and the judicious use of laboratory testing. The diagnostic methodologies currently available, including cardiac evaluation, video-EEG monitoring, and polysomnography, will frequently result in a specific diagnosis, and allow appropriate treatment. In many cases, however, even after the above diagnostic tests have been utilized, no diagnosis is forthcoming, but reassurance and follow-up can be of help to the young patient and the family.