Benign Movement Disorders Mimicking Seizures in Children: A Retrospective Cohort Study

Background: Developmental and benign movement disorders (DBMD) are a common but often under-recognized cause of referral in children with suspected seizures, frequently leading to misdiagnosis and unnecessary treatment. Methods: This retrospective cohort study included 453 children evaluated for suspected seizures between January 2019 and January 2024. Patients with epilepsy, cerebral palsy, metabolic disorders, significant developmental delay, psychiatric conditions, or structural brain abnormalities were excluded. DBMD was diagnosed in 113 patients based on clinical evaluation by experienced pediatric neurologists and established diagnostic criteria. Demographic characteristics, diagnostic distribution, age at presentation, and electroencephalography (EEG) findings were analyzed. Prevalence was calculated with 95% confidence intervals (CIs). Group comparisons were performed using chi-square tests and one-way ANOVA with Tukey post hoc analysis. Results: The prevalence of DBMD was 24.9% (95% CI: 21.2-29.1), corresponding to nearly one in four children referred with suspected seizures. Breath-holding spells were the most common diagnosis (6.6% of the total cohort; 26.5% of DBMD cases), followed by Sandifer syndrome and non-epileptic staring episodes. Age at presentation differed significantly between diagnostic groups (p = 0.001), with breath-holding spells occurring at younger ages and staring episodes at older ages. EEG findings were normal in 80.5% of patients, and no diagnosis-specific epileptiform patterns were identified. No patients were observed to develop epilepsy during the follow-up period. Conclusions: DBMD accounts for a substantial proportion of children referred for suspected seizures. Recognition of age-specific clinical patterns and predominantly normal EEG findings may improve diagnostic accuracy and help avoid unnecessary investigations and antiepileptic treatment.