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Shuddering attacks in children: A retrospective analysis of 19 cases from a single-center in Turkey
Selcan Ozturk1, Yakup Peduk1, Hakan Gumus1
1Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Insights
Shuddering attacks (SA) in infants may be linked to teething, which could trigger or worsen symptoms. Further research is needed to understand the exact cause of these common nonepileptic events.
Area of Science:
- Pediatric Neurology
- Childhood Paroxysmal Nonepileptic Events
Background:
- Shuddering attacks (SA) are common nonepileptic events in infants, typically starting between 4-6 months.
- Triggers include feeding and stimulation, but the underlying cause of SA remains unclear.
- Previous assumptions suggested no further research was needed due to expected spontaneous regression.
Purpose of the Study:
- To investigate the causes and clinical conditions associated with SA.
- To explore differential diagnoses for SA.
- To determine the utility of video-electroencephalogram (V-EEG) in diagnosing SA.
Main Methods:
- Retrospective analysis of 19 pediatric cases diagnosed with SA.
- Investigation of factors like family/birth history, age, sleep, teething, V-EEG, brain imaging, and comorbidities.
- Data collected from Erciyes University Pediatric Neurology Clinic database.
Main Results:
- Gastroesophageal reflux was noted in 4 cases; epilepsy and Marcus Gunn Jaw Winking Syndrome in one case each.
- No other accompanying conditions were identified in the remaining cases.
- Symptom onset in 78.9% of cases coincided with the teething period.
Conclusions:
- A potential indirect link between shuddering attacks and teething is suggested.
- Teething may act as a triggering or aggravating factor for SA.
- Further investigation into the relationship between teething and SA is warranted.
Background:
Shuddering attacks (SA) are one of the most common childhood paroxysmal nonepileptic events (PNEs). These attacks usually start between the first 4th and 6th months of life with rapid tremors of the head and adduction of the arms and knees. A number of factors including eating, breastfeeding, and playing stimulating games have been shown to trigger the attacks; however, the exact pathogenesis remains unknown. It has been stated that there is no need for further research in patients diagnosed, and spontaneous regression is expected.
Purpose:
This study aimed to identify the causes, accompanying clinical conditions, possible differential diagnosis of SA, and the role of video-electroencephalogram (V-EEG) recording for accurate diagnosis.
Methods:
Nineteen cases with SA have been collected from the database of Erciyes University Pediatric Neurology Clinic, where 52.6% are boys (n = 10) and 47.6% are girls (n = 9). The relationship between the onset and disappearance of SA symptoms and variables including family history, birth history, age, sleep, teething during SA, video-EEG recordings, brain imaging, and accompanying conditions such as epilepsy have been investigated by retrospective analysis.
Results:
Four cases were found to have gastroesophageal reflux, one had epilepsy, and one had Marcus Gunn Jaw Winking Syndrome. No accompanying conditions could be identified for rest of the cases. It was observed that onset of symptoms in 15 (78.9%) of 19 cases coincided remarkably with the period of teething.
Conclusion:
We speculate that there might be an indirect link between SA and teething and teething may be a triggering or an aggravating factor for SA.