Recurrent paroxysmal nonepileptic disorders

Abstract

Summary o 1. Paroxysmal disorders of infancy, childhood and adolescence include breath-holding spells, syncope, narcolepsy, disturbances of arousal, vertigo, and headache due to migraine, seizure equivalents or depression. Abdominal pain and cyclic vomiting are also recurrent symptoms which can be seen with migraine or seizure states. 2. The physiologic mechanism underlying breath-holding spells, idiopathic syncope, cough syncope and micturition syncope are probably similar. 3. Narcolepsy can be separated from syncope on the basis of polygraphic studies. The narcoleptic tetrad appears to be an aberration of REM sleep. In contrast, nocturnal enuresis, somnambulism and night terrors are aberrations of NREM sleep and arousal. 4. Vertigo as a recurrent paroxysmal symptom can occur as an idiopathic event, in association with infection, possibly as a migrainous equivalent, and certainly as a seizure aura. 5. Headache is a symptom of many structural diseases and the differential diagnosis of its etiology should include diseases of head, chest, abdomen and vascular system before one considers the more commonly associated entities of migraine, seizure states or depression. 6. Migraine is regarded as a vascular phenomenon involving both intracranial and extracranial blood vessels. It has a wide variety of clinical manifestations some of which are difficult to differentiate from epilepsy. 7. Migraine, psychomotor epilepsy or seizure equivalents can be the basis of several paroxysmal syndromes, the major symptoms of which include headache, abdominal pain and cyclic vomiting. 8. Headache, both migrainous and nonmigrainous can occur as a symptom of depression in childhood and adolescence.