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Paroxysmal tonic upgaze mimicking epileptic seizures in infancy: a diagnostic challenge

Raffaele Falsaperla1, Vincenzo Sortino2,3, Catia Romano4

  • 1Department of Medical Science-Pediatrics, University of Ferrara, 44124, Ferrara, Italy. raffaele.falsaperla@unife.it.

Documenta Ophthalmologica. Advances in Ophthalmology
|August 22, 2026
PubMed

Insights

Paroxysmal tonic upgaze (PTU) causes brief upward eye deviations in infants, mimicking seizures. Recognizing PTU avoids misdiagnosis and unnecessary treatments for epilepsy.

Area of Science:

  • Pediatric Neurology
  • Ophthalmology
  • Epileptology

Background:

  • Paroxysmal tonic upgaze (PTU) is a rare paroxysmal disorder.
  • It can be mistaken for epileptic seizures in infants, leading to diagnostic challenges.

Purpose of the Study:

  • To detail the clinical presentation of paroxysmal tonic upgaze (PTU).
  • To emphasize PTU's potential to be misdiagnosed as infantile epileptic seizures.

Main Methods:

  • Case report of an 11-month-old infant experiencing recurrent upward eye deviations.
  • Evaluations included neurological exams, psychomotor assessment, transfontanellar ultrasound, and video electroencephalography (EEG).

Main Results:

  • Episodes of sustained upward eye deviation increased in frequency without affecting consciousness or tone.
  • Normal neurological and developmental assessments, unremarkable ultrasound, and absence of epileptiform activity on video EEG.
  • Clinical features and normal findings supported a diagnosis of PTU.

Conclusions:

  • Accurate identification of PTU as a non-epileptic condition is crucial.
  • Avoids misdiagnosis of epilepsy and unnecessary interventions in infants.
Abstract

Keywords:
EEGEyesParoxysmal tonic upgazeWES

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