Nonconvulsive epileptiform activity appearing as ataxia

Ataxia may be the result of otherwise silent epileptiform activity. We studied three patients, between 3 and 5 years of age, whose initial complaint was unsteadiness of gait. Each one of the patients had an epileptiform EEG with bursts of slow spike and wave activity. Each had normal results of diagnostic studies for other causes of ataxia. Specifically, none had anticonvulsant drug levels in the toxic range. Modification of the anticonvulsant regimen resulted in dramatic clinical and EEG improvement. Nonconvulsive epileptiform activity has been called pseudoataxia in the scant literature on this subject. This process should be considered in the evaluation of ataxia in children.