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Apneic attacks in children can be a sole or accompanying symptom of epileptic seizures. These seizures, often linked to the limbic system, manifest as respiratory issues and cyanosis, confirmed by EEG.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Epileptic seizures can present with diverse and sometimes atypical symptoms.
- Apneic attacks, characterized by respiratory compromise, are rarely recognized as a primary manifestation of epilepsy in children.
Observation:
- Five pediatric cases of apneic attacks as a manifestation of epileptic seizures were reported.
- Apneic seizures, lasting 1-2 minutes, involved respiratory embarrassment and early cyanosis, with impaired consciousness difficult to assess in infants.
- Ictal electroencephalograms (EEGs) consistently showed focal onset paroxysmal discharges, predominantly in temporal, frontal, or central areas.
Findings:
- In three children, apneic attacks were the exclusive seizure symptom; the other two experienced additional seizure types.
- EEG findings included high-amplitude theta-waves, sharp waves, spikes, or fast/slow wave complexes.
- Interictal EEGs were largely unremarkable, highlighting the diagnostic importance of ictal recordings.
Implications:
- Apneic attacks in infants are considered an integral component of complex partial seizures, often originating in the limbic system.
- Recognition of these seizures is crucial for accurate diagnosis and appropriate management of pediatric epilepsy.
- This highlights the need for thorough neurological evaluation, including EEG, in infants presenting with unexplained apneic episodes.
Abstract:
Five children who had apneic attacks as a manifestation of epileptic seizures are reported. In three children, the apneic attacks were the sole symptom of epileptic fits. The other two children had additional types of seizures. The apneic seizures usually lasted one to two minutes and were characterized by respiratory embarrassment rather than complete arrest. These seizures are usually accompanied by cyanosis which appears early during the course of the attack. Although consciousness seemed to be impaired, this was difficult to assess accurately in infants. The ictal EEGs disclosed paroxysmal discharges of focal onset in all cases, consisting of high amplitude theta-waves, gradually mixed with or replaced by sharp waves or spikes in some and fast waves followed by slower waves in others. These occurred in temporal areas in three patients and in frontal and central areas in one patient each. Interictal EEGs, however, revealed paroxysmal discharges in only one patient. Apneic attacks in these infants are considered to be an integral part of the manifestations of complex partial seizures originating mostly in the limbic system.