Conditions mimicking Seizures

Conditions mimicking SeizuresAhmad Irfan0308178 Batch 4 MBBS

SeizuresAberrant electrical activity of the brainImportant signs of severe brain disorder Its important to distinguish between non-epileptic behaviours before pharmacologic treatment is started

Conditions mimicking seizuresAre these paroxysmal events an epilepsy of childhood or one of various conditions mimicking it?Best identified with simultaneous EEG recordings and video monitoringElectrolytes and metabolic testingSerum glucose CSF investigations (infectious causes)Imaging-MRISyncopeMost common non-epileptic cause of altered consciousnessVasovagal reflex that occurs in otherwise healthy individuals like children or young adultsTriggers include:-prolonged standing -rising from lying-hot stuffy environments-emotional trauma & painImportant to note prodromal symptoms developing 1-5 minutes before (presyncope)-light headedness, nausea, sweatingpalpitations, blacking of vision, muffled hearing

SyncopeSeizureTriggerCommon (upright, bathroom, blood, needles)Rare (flashing lights, hyperventilation)ProdromeAlmost always (presyncope)Common (aura)OnsetGradual (often minutes)Usually suddenDuration130 seconds13 minutesConvulsive jerksCommon (brief)Common (prolonged)IncontinenceUncommonCommonLateral tongue biteVery rareCommonColourVery palePale (simple partial seizure) Red, blue (tonic-clonic seizure)Post-ictal confusionRare (eg, wakes on floor)Common (eg, wakes in ambulance)RecoveryRapid (quickly orientated)Slow (confused)Breath holding attacksSometimes happens when the toddler is upsetThey will hold their breath and turn blueSometimes may lead to loss of consciousness however they recover fully and rapidlyAttacks usually do resolve, but a behavior modification therapy or distractions may help

Shuddering attacksAppears to be cold as if ice water was being poured down ones back (chills)Flexion of head, trunk, elbows and knees with adduction of limbsStarts in infancy and usually abates during childhood

Benign neonatal sleep myoclonusInfant has myoclonic jerks during sleepCan be a dramatic event involving all four extremities Ceases immediately upon waking

Reflex anoxic seizures Neither epileptic nor cyanotic (breath holding)Brief stoppage of heart due to excessive vagus nerve activitySome triggers: -pain, discomfort due to trauma,Cold food (icecream), fright, feverChild becomes pale, may fall and the hypoxia may induce a generalised tonic clonic seizure It is brief and recovery is rapid

Gastroesophageal refluxInfants may have stiffening/crying episodes that may be suggestive of spasmsIn older children and adults who are cognitively impaired its reminiscent of a tonic clonic seizureSandifer syndrome describes the abnormal posturing in reflux patientsImportant to notice the relationship with feeding, easy to misinterpret as seizures-sudden rotation of head and neck and legs with stretched out appearance, arching of back with hyperextensionSelf-gratification behaviourStimulation of genitalia to achieve comfort rather than sexual gratification-child may be stopped during gratification if distracted, may show anger or annoyanceBehaviours manifested:-dystonic posturing, grunting, rocking, eidetic imagary, sweatingImportant differential diagnosis of epilepsy, home videos often prevent unnecessary investigations and treatment

ReferencesLissauer T, Clayden G, Craft A. Illustrated Textbook of Paediatrics. 4th ed., Edinburgh: Mosby/ Elsevier; 2012.Tasker R, McClure R, Acerini C. Oxford handbook of paediatrics [Internet]. Oxford : Oxford University Press; 2013.A Nechay, LM Ross, JBP Stephenson, MO Regan. Gratification disorder: a review. Community child health, public health and epidemiology. Arch Dis Child [Internet]. 2004 [cited 2015 Aug 11];89(3):225-226. Available from: doi:10.1136/adc.2003.032102Smith PEM. If its not epilepsy. J Neurol Neurosurg Psychiatry [Internet]. 2001 [cited 2015 Aug 11]:70(2):9-14. Available from: doi:10.1136/jnnp.70.suppl_2.ii9