NON EPILEPTIC PAROXYSMAL EVENTS IMITATING EPILEPSY IN CHILDREN

Abstract

Differential diagnosis of epileptic seizures with non epileptic paroxysmal events often have serious difficulties. The most various states which are observed at somatic, neurologic, psychiatric disorders and even at healthy children imitate an epilepsy. Objective. Evaluation of reliability of the diagnosis “epilepsy” in patients referred to the epilepsy center. Material and methods. 2015 patients referred to our epilepsy center for evaluation and treatment for 3-year period. Age from 0 to 21 years. Methods of diagnosis: clinical examination, video-EEG monitoring (VEEG) of 6 to 120 hours, brain MRI. Results. The diagnosis of “epilepsy” was reliably confirmed in 1552 patients (77%). Among these, 101 (6,5%) patients were diagnosed late (later than 6 months from the onset with seizures frequency more often than 1 time per month). At 463 (23%) patients overdiagnosis has been established – the diagnosis epilepsy with the current seizures was established unreasonably. Among them we have identified the following 3 groups: healthy children – 57 patients (12.3%); somatic and neurological disorders – 323 patients (70%); psychogenic non-epileptic seizures (PNES) – 83 patients (18%). The most frequently seizures was imitated by hyperkinetic movement disorders – 40.4% (187 patients), including paroxysmal dyskinesia, hyperkinetic eye movements, pathological nonepileptic myoclonus, jitteriness, shuddering attacks, benign neonatal sleep myoclonus, tics, hyperekplexia, benign myoclonus of early infancy, benign paroxysmal torticollis, spasmus nutans. Among the frequent reasons of over-diagnosis of epilepsy were also parasomnias and PNES. Conclusions. The most frequent diagnostic errors were linked to the lack of objective information about the nature of paroxysms and misinterpretation of the EEG. VEEG is the most valuable tool in the differential diagnosis of epilepsy