Abstracts

Rationale: Paroxysmal non-epileptic events are frequently encountered in children; however there is little information about the detailed event semiology in the very young. We report our experience with non-epileptic paroxysmal events in a group of infants and toddlers and analyze the nature and clinical characteristics of the events.Methods: We retrospectively reviewed all video EEG (VEEG) studies performed at Rainbow Babies and Children s Hospital between January 2010 and April 2011 in consecutive patients 2 years old or younger who had non-epileptic events recorded. Semiological analysis of the events included: type of event (behavioral, motor, autonomic), time of occurrence (awake/sleep), clear onset and end, and precipitating factors. Results: Eighty one patients aged 2 years old or younger had VEEG during the study period. Thirty one of them (38.3%) had non-epileptic events; 12 girls and 19 boys (P>0.05). Three patients had both epileptic and non-epileptic seizures and 28 had only non-epileptic events. Six had abnormal interictal EEG, including the 3 patients with epileptic seizures. Eight had a family history of epilepsy or seizures (25.8%). Ten were developmental delayed, and eleven had neurological abnormalities. Events occurred during wakefulness in 16 patients (51.6%, P<0.001); during sleep in 7 (22.6%); in both, awake and sleep in 7 (22.6%) and during arousal from sleep in one. On semiology analysis, 20 had behavioral features (64.5%), 10 with arrest of activity, 8 with staring, 6 with crying and 5 with vocalization. 23 had motor features (74.2%) and 9 had autonomic features (29.0%). Events were classified as: staring spells in 8 cases (25.8%), normal infantile behavior in 7 cases (22.6%), sleep myoclonus in 7 patients (22.6%), shuddering attacks in 4 patients (12.9%), infantile masturbation in 4 (12.9%), tic in one, choreoathetosis in one, hyperekplexia in one, gastro-esophageal reflux in one and an episode of discomfort in one. Three out of 7 patients (42.9%) with normal infantile behavior had family history of epilepsy or seizures versus 5 out of 24 patients (26.3%) with other paroxysmal diagnosis (26.3%) (P<0.001). Conclusions: Paroxysmal non-epileptic events are very common in infants and toddlers. As opposed to older children and adults, non-epileptic events were more common in males than females in the studied group. Non-epileptic staring spells are the most common paroxysmal non-epileptic event seen in this age group. In many children, normal infantile behaviors were misread as seizures by the family members. One reason for this could be worries about a family history of epilepsy or seizures.