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Partial seizures presenting as life-threatening apnea
B Singh1, A al Shahwan, S M al Deeb
1Department of Paediatric Neurology, Riyadh Armed Forces Hospital, Saudi Arabia.
Insights
Apneic episodes in infants can be misdiagnosed. Video EEG monitoring is recommended to differentiate apneic seizures from other causes, preventing harmful treatments.
Area of Science:
- Pediatric Neurology
- Neonatology
- Epileptology
Background:
- Apneic episodes are common in newborns but rare after one month, with differential diagnoses including gastroesophageal reflux, cardiac arrhythmias, idiopathic central apnea, and seizures.
- Accurate diagnosis of apnea is crucial as treatments vary significantly and can be detrimental; for instance, caffeine for presumed idiopathic central apnea has precipitated seizures in some cases.
Observation:
- Two infant cases of partial seizures presenting as apnea were studied.
- Interictal electroencephalogram (EEG) was normal in one patient and showed focal spikes in the other.
- 16-channel video EEG monitoring revealed focal ictal discharges from temporal areas preceding apnea onset in both patients.
Findings:
- Partial seizures can manifest as apneic episodes in infants.
- Video EEG monitoring effectively identified focal ictal discharges preceding apnea, confirming seizures as the cause.
Implications:
- Video EEG monitoring is essential for accurate diagnosis of apneic episodes in infants when seizures are suspected.
- This diagnostic approach can prevent misdiagnosis and guide appropriate, potentially life-saving, therapeutic interventions.
- Relying solely on interictal EEGs can be unreliable, underscoring the importance of comprehensive video EEG monitoring.
Abstract:
Apneic episodes, quite common in newborns, are considered rare after age 1 month, when gastroesophageal reflux, cardiac arrhythmias, idiopathic central apnea, and seizures become included in differential diagnosis. Determining the cause of apnea is important as treatment differs significantly and can be harmful; Caffeine given for presumed idiopathic central apnea is reported to have precipitated seizures in 2 patients with apneic seizures. Two cases of partial seizures presenting as apnea in infants were studied. Interictal EEG was normal in 1 and showed focal spikes in the other. Video EEG monitoring (16 channel) showed focal ictal discharge originating from temporal areas clearly preceding onset of apnea in both patients. Because therapeutic options are sometimes diametrically opposite and interictal EEGs are particularly unreliable for diagnosis, we recommend video-EEG monitoring if there is any doubt about the diagnosis before starting treatment in patients with apneic episodes.