Conditions that Mimic Seizures

1. Conditions that Mimic Seizures Prepared by Dr.Hani Daoud Discussed by Dr.Afaf Al-arene

2. Conditions that Mimic Seizures • Several conditions share common features with epilepsy, because these disorders may be associated with altered levels of consciousness, tonic or clonic movmenents, or cyanosis.

3. Benign Paroxysmal Vertigo • Typically develops in toddlers and is relatively rare beyond 3 yr of age. • The attacks develop suddenly associated with ataxia causing the child to fall or refuse to walk or sit. • The child appears frightened and pale • Nausea & vomiting may be prominent • Consciousness and the ability to verbalize are not disturbed.

4. Benign Paroxysmal Vertigo • The attacks vary in duration (seconds to minutes), frequency (daily to monthly). • Neurologic evaluation yield negative results. • Patients with clusters of attacks usually respond to diphenhydramine, 5 mg/kg/24 hr PO, IM, IV, or per rectum.

5. Night terrors • Common in boys 5-7 yr of age. • Occur in 1-3%of children and usually short-lived. • The child screams and appears frightened with dilated pupils, tachycardia, and hyperventilation. • Little or no verbalization. • Sleep follows in a few minutes. • Short course of Diazepam or Imipramine may be considered.

6. Breath-Holding Spells • A breath-holding spell can be a frightening experience for parents because the infant becomes lifeless and unresponsive . • There are two major types of breath-holding spells: the more common cyanotic form and t he pallid form.

7. Cyanotic Spells • The episode is heralded by a brief, shrill cry followed by forced expiration and apnea. • There is a rapid onset of generalized cyanosis and a loss of consciousness that may be associated with repeated generalized clonic jerks, opisthotonus, and bradycardia. • Normal EEG.

8. Cyanotic Spells • Rare before 6 months of age. • They peak at about 2 yr of age, and they abate by 5 yr of age. • The management is support and reassurance of the parents.

9. Pallid Spells • Less common than breath-holding spells. • Initiated by a painful experience such as falling and striking the head, the child stops breathing, rapidly loses consciousness, becomes pale and hypotonic. • Bradycardia may occur. • Management by conservative measures and atropine sulfate in some cases.

10. Syncope

11. Simple Syncope • Syncope follows an alteration in brain metabolism, the consequence of decreased cerebral blood flow, usually secondary to systemic hypotension. • During a syncopal episode, a child may have fixed upward deviation of the eyes that can be confused with epilepsy.

12. Simple Syncope • Simple syncope results from vasovagal stimulation and is precipitated by pain, fear, excitement, and extended periods of standing still particularly in warm environment. • EEG shows transient slowing during the attack but no seizure discharges. • Uncommon before age 10-12 yr.

13. Cough Syncope • This is most common in asthmatic children and shortly after the onset of sleep. • The patients face becomes plethoric, and the child becomes agitated, and is frightened. • Loss of consciousness is associated with generalized muscle flaccidity, vertical upward gaze and urinary incontinence. • Recovery begins within seconds, and consciousness restored few minutes later.

14. Prolonged QT Syndrome • It is characterized by sudden loss of consciousness during exercise or an emotional and stressful experience. • During the period of syncope, various cardiac arrhythmias are evident. • The child may recover within minutes or die during the event. • Prolonged QT more than 0.46 msec support the diagnosis. • B-Adrenergic- antagonist drugs are usually effective and may be lifesaving.

15. Paroxysmal Kinesigenic Choreoathetosis • Characterized by a sudden onset of unilateral or bilateral choreoathetosis or dystonic posturing of a leg or an arm and associated facial grimacing and dysartheria. • The condition precipitated by sudden movement or by excitement & stress. • Never associated with loss of consciousness. • EEG & neurological examination are normal and managed by anti-convulsants.

16. Benign Paroxysmal Torticollis of Infancy • They have recurrent attacks of head tilt associated with pallor, agitation, and vomiting with an onset between 2 and 8 months of age. • During the attack the child resist passive head movement. • No loss of consciousness and spontaneous remission occurs by 2-3 yr of age.

17. Narcolepsy and Cataplexy • Narcolepsy is a disorder that rarely begins before adolescence and is characterized by paroxysmal attacks of irrepressible daytime sleep which is sometimes associated with transient loss of muscle tone (cataplexy). • An EEG shows that the recurrent sleep attacks consist of REM sleep. • Modafinil acetamide use as management of narcolepsy.

18. Episodic Dyscontrol Syndrome • Patients develop sudden and recurrent attacks of violent physical behavior as kicking, scratching, biting, and shouting. • An affected child cannot seem to control the behavior and may seem like psychotic. • EEG distinguish it from complex partial seizures.

19. Pseudoseizures • Occur typically between 10 and 18 yr of age and are more frequent among girls. • Occur with patients with a past history of epilepsy. • There are several distinguishing features of pseudoseizure, including lack of cyanosis, normal reaction of the pupil to light, no loss of sphincter control, normal plantar responses, and absence of tongue biting.

20. Pseudoseizures • The most reliable method of differentiation epilepsy from suspected pseudoseizures is to record an attack. • The EEG shows an excess of muscle artifact during the pseudoseizure. • After a true epileptic seizure, there is a significant increase in serum prolactin whereas pseudoseizure not.

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