Seizure-like States

Abstract

1. Kathryn McVicar, MD 1. Children’s Hospital at Montefiore Bronx, NY Seizure-like episodes resemble seizures, but are not true seizures. Breath-holding spells (BHS), tics, syncope, gastroesophageal reflux (GER), and sleep disturbances all may be mistaken for seizures, but important distinguishing features can help the clinician differentiate these entities from a true seizure. Like seizures, seizure-like states are paroxysmal events that have a discrete onset, ending, and return to baseline. The duration, frequency, and clinical characteristics are different for each entity and help the clinician distinguish among them, usually on the basis of history and physical examination, sometimes with the aid of additional diagnostic testing. Seizures are disturbances of the central nervous system characterized by phenomena that the patient cannot control, with or without a concurrent loss of consciousness. There may be major motor manifestations. The range of clinical seizures extends from subtle behavioral arrests (absence seizures) to the more obvious generalized tonic-clonic seizures. Generally, consciousness is lost, and the postictal period of drowsiness or decreased responsiveness following the episode often lasts 21/2 times the length of the actual paroxysm. If the paroxysm is momentary, a postictal period may not be identifiable. BHS are common, peaking in children between 2 and 3 years of age, although even infants may have them. Commonly, those who hold their breath outgrow their spells by 5 or 6 years of age. BHS are characterized by the child’s apparent inability to breathe, accompanied by a change in color, limpness, and collapse, followed briefly by a return to baseline. The duration usually is less than 1 minute. Generalized tonic movements from brief cerebral ischemia may accompany BHS, but do not imply any increased risk of epilepsy in the future. Clinically, BHS can be categorized as pallid or cyanotic. The parents often describe the child as becoming frustrated and crying prior to cyanotic episodes and having suffered minor trauma, …