Home Video Recording Research Articles

Socio-Demographic and Clinical Profile of Infantile Masturbation Syndrome

Background: Masturbation is not uncommon in younger children. Due to variable presentation in early childhood often leads to misdiagnosis and may result in unnecessary investigation and treatment. Materials & Method: This retrospective case study was conducted at outpatient department of Rehabilitation and Neurology unit of Dr.M R Khan Shishu Hospital and Institute of Child Health between 2013-2019. Result: Among 40 patients, majority (90%) had age of onset within 36 months of age. Mean and median age were 27.45 months and 25.5 months respectively, the range was between 4 months to 84 months. Male: female was 1:1.2. Most of the children came from urban area (85%) and from single family (77.5%). All 40 children shared common features like stereotype movement with variable duration, no alteration of consciousness, cessation with distraction when attempted, remained responsive during the events, their neurological examination was normal and no abnormalities were detected in laboratory studies. Thirty- three (82.5%) children did this behaviour on prone position. Thirty-one (77.5%) children had vocalization. Duration of episode was 5-10 min in 19(47.5%) children. Frequency of masturbation was up to 5 times per day in 30(75%) children. Twenty-two (55%) children did this behaviour when remained unnoticed. Antiepileptic drug was given to 14(35%) children but had no clinical improvement. Home video recordings were available in 18(43.9%) children. Conclusion: Early diagnosis from the knowledge of clinical manifestations helps to minimize unnecessary laboratory investigations and use of drugs. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 71-75

Video Analyses of Sudden Unexplained Deaths in Toddlers.

More than 2,900 US children aged younger than 4 years die from unknown causes each year, accounting for more than 219,000 life years lost annually. They are mostly sleep-related and unwitnessed with unremarkable autopsies, limiting our understanding of death mechanisms. We sought to understand potential mechanisms of death by evaluating videos of sudden deaths in toddlers. In our registry of 301 sudden unexplained child deaths, a series of 7 consecutively enrolled cases with home video recordings of the child's last sleep period were independently assessed by 8 physicians for video quality, movement, and sound. Four boys and 3 girls (13-27 months at death) with terminal videos shared similar demographic features to the 293 other registry cases without video recordings. Five video recordings were continuous and 2 were triggered by sound or motion. Two lacked audio. All continuous recordings included a terminal convulsive event lasting 8-50 seconds; 4 children survived for >2.5 minutes postconvulsion. Among discontinuous videos, time lapses limited review; 1 suggested a convulsive event. Six were prone with face down, and 1 had autopsy evidence of airway obstruction. Primary cardiac arrhythmias were not supported; all 7 children had normal cardiac pathology and whole-exome sequencing identified no known cardiac disease variants. Audio-visual recordings in 7 toddlers with unexplained sudden deaths strongly implicate that deaths were related to convulsive seizures, suggesting that many unexplained sleep-related deaths may result from seizures.

Parents’ lived experience of early risk assessment for cerebral palsy in their young child using a mobile application after discharge from hospital in the newborn period

Introduction General Movement assessment (GMA) is considered the golden standard for early identification of infants with a high risk of developing cerebral palsy (CP). The aim of this study was to explore parents’ lived experience of early risk assessment for CP using a mobile application for home video recording after discharge from hospital stay in the newborn period. Methods An inductive qualitative design using a hermeneutical phenomenological approach was chosen, and fourteen parents with children at risk of CP were interviewed at home. The hermeneutical phenomenological approach describes humans’ lived experiences of a specific phenomenon with a possibility of deeper understanding of the expressed statements. The interviews were analyzed using the fundamental lifeworld existential dimensions as guidelines for describing the parents’ lived experience. Results The overall understanding of the parents’ experience was ‘Finding control in an uncontrolled life situation'. During the often-long hospitalizations, the parents struggled with loss of control and difficulty in understanding what was going on. The use of the mobile application followed by a swift result made them feel in control and have a brighter view of the future. Conclusions The findings suggest that the mobile application did not seem to worry the parents. Instead, it provided the parents with a sense of active participation in the care and treatment of their child. The mobile application should be accompanied with clear instructions and guidelines for the parents and details about how and when the result is given.

Sleep-related rhythmic movement disorder in children: a mini-review.

Sleep-related rhythmic movement disorder (SRRMD) occurs in both infants and children. This disorder rarely occurs or persists in adolescence or adulthood. Rhythmic movement during sleep in children is often asymptomatic and considered a benign condition. It is classified as SRRMD when movement significantly disrupts sleep, results in daytime functional impairment, or causes self-inflicted body injury. Several studies have demonstrated that SRRMD occurs in all sleep stages. Few studies have investigated rhythmic movement disorder (RMD) in children. SRRMD is a clinical diagnosis supported by home video recordings. When the clinical history is insufficient to provide a definitive diagnosis of SRRMD, and other sleep-related conditions or seizure disorders are suspected, video-polysomnography is indicated. There are currently no clinical guidelines for treating SRRMD.

Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults.

Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.

A Video is Worth a Thousand Words: The Use of Home Videos in Pediatric Neurology.

The use of home video recordings (HVRs) may aid in the diagnosis of neurological disorders. However, this practice remains underutilized. Through an anonymous survey, we sought to understand the perspectives of healthcare providers regarding the sharing of HVRs alongside referrals for responsive and economical pediatric neurology care. This was timely given COVID-19 has worsened wait times for diagnosis and consequently treatment. Most providers agree that sharing of HVRs improves patient care (93.1%: 67/73) and prevents both additional investigations (67%: 49/73) and hospital admissions (68.5%: 50/73). However, a minority of providers (21.9 %: 16/73) currently share HVRs alongside their referrals.

Frugal digitization of analog video endoscopic medical records in a Kenyan rural medical center

Background: Digitization of healthcare data has led to widespread healthcare transformation. This has been enhanced by the availability of new technologies at lower costs. Video recording can improve the quality of care, provider skills, education, and patient follow-up. However, limitations such as the risk of litigation, patient privacy, and poor legal framework have curtailed adoption. Rural hospitals have older analog equipment due to limited financial resources. Objectives: This study aims to present an alternative low-cost option. Methods: We present an economical method of recording and digitizing endoscopic and laparoscopic procedures performed on analog video processing towers. We showcase a video of the step-by-step procedure that involves connecting a digital video home system (VHS) video recorder to an analog Olympus endoscopy machine (Model CV-100) and transferring media via a portable storage device to an electronic medical record database. Conclusion: Using simple home video recording devices provides a low-cost solution to creating digital records from analog video endoscopic machines. The technique, however, creates additional steps to the endoscopy process and the need for capacity building of the endoscopist. Patient consent forms should cover video creation. Medical centers should have a robust information management system to securely store and retrieve digitized video records.

Isolated Unilateral EEG Findings in Juvenile Myoclonic Epilepsy: A Case Report

Juvenile myoclonic epilepsy (JME) has well-defined clinical and electrophysiological features. On the other hand, large case series have shown that focal and asymmetrical discharges may accompany generalized epileptiform activities in JME. Although it is known that these non-generalized electrophysiological findings do not exclude the diagnosis of this syndrome, some findings may create confusion in the differential diagnosis. In this case report, a case of JME with electroencephalographic findings characterized by isolated unilateral epileptiform activities without typical generalized discharges was discussed. The current case clinically presented with involuntary jerk movements in the bilateral upper extremities. It has been determined that these movements are uni/bilateral myoclonic beats based on home video recordings. Metabolic, toxic and structural problems were excluded in the investigations for the etiology of myoclonus. In the electrophysiological examination performed for epileptic processes, epileptiform discharges localized to the isolated right hemisphere were observed. JME was considered primarily due to clinical findings in the patient, and effective seizure control was achieved in a 4-year follow-up under anti-seizure treatment. The peculiarity of the case is the presence of electrophysiology recordings of isolated unilateral epileptiform activity during the 4-year follow-up period. It should be emphasized that there is no case of JME diagnosed with isolated unilateral epileptiform activity in the absence of generalized spike-slow waves or multiple spike-slow waves in the literature.

Vocalisation Repertoire at the End of the First Year of Life: An Exploratory Comparison of Rett Syndrome and Typical Development

Rett syndrome (RTT) is a rare, late detected developmental disorder associated with severe deficits in the speech-language domain. Despite a few reports about atypicalities in the speech-language development of infants and toddlers with RTT, a detailed analysis of the pre-linguistic vocalisation repertoire of infants with RTT is yet missing. Based on home video recordings, we analysed the vocalisations between 9 and 11 months of age of three female infants with typical RTT and compared them to three age-matched typically developing (TD) female controls. The video material of the infants had a total duration of 424 min with 1655 infant vocalisations. For each month, we (1) calculated the infants’ canonical babbling ratios with CBRUTTER, i.e., the ratio of number of utterances containing canonical syllables to total number of utterances, and (2) classified their pre-linguistic vocalisations in three non-canonical and four canonical vocalisation subtypes. All infants achieved the milestone of canonical babbling at 9 months of age according to their canonical babbling ratios, i.e. CBRUTTER ≥ 0.15. We revealed overall lower CBRsUTTER and a lower proportion of canonical pre-linguistic vocalisations consisting of well-formed sounds that could serve as parts of target-language words for the RTT group compared to the TD group. Further studies with more data from individuals with RTT are needed to study the atypicalities in the pre-linguistic vocalisation repertoire which may portend the later deficits in spoken language that are characteristic features of RTT.

Transient infant movements (TIM): frequent infant non-pathological developmental motor phenomena.

Lombroso and Fejerman, in 1977, described non-epileptic movements in normal infants and named them "benign myoclonus of early infancy", which were recently relabelled by Fernandez-Alvarez as "benign polymorphous movement disorder of infancy" (BPMDI). The focus of our study was to describe, categorize and point out the peculiar clinical representations of these heterogeneous phenomena through our video footage, particularly to those less experienced in paediatric neurology. We included all infants with a video-EEG performed at our unit or a home video recording of "Fejerman-Lombroso", "benign myoclonus of early infancy", "shuddering attacks" or "paroxysmal non-epileptic movements". Twenty-one children were selected. Age at onset ranged between two and 13 months, age at disappearance ranged between seven and 16 months, age at recording ranged between four and 16 months, and duration of the phenomena ranged between two weeks and 19 months. In total, 85% infants had normal neurodevelopment at onset and follow-up (mean follow-up: 31.47 months) and 15% presented with neuropsychological or neurosensory deficits. We distinguished four different patterns of movements: movement of the head in 50%, shuddering attacks in 30%, tonic brief contractions of the trunk and limbs in 10%, and elevation of the shoulders in 10%. These motor phenomena do not affect neurological status and are not associated with developmental delay. Considering that clinical interpretation may be challenging, especially relative to epileptic seizures, we present an explanatory video of these characteristic events. We also propose a new definition that is simple to remember: "transient infant movements" (TIM).

The Clinical Value of Patient Home Videos in Movement Disorders.

Background:Numerous studies have shown the value of patient home video recordings within the field of epilepsy. Despite the growing influence of mobile technology and telemedicine, there is a paucity of studies examining the role of home videos in the diagnosis of movement disorders.Objective:To characterize the clinical value of patient home videos in a movement disorders practice.Methods:We performed a retrospective review from our video database over the past 10 years and identified 20 encounters where an in-person, clinic evaluation and studio video were supplemented by a home video. We reviewed these encounters to determine if the home video added additional value to the clinic video. The home videos were screened by 3 movement disorders attendings and 3 movement disorders fellows to assess for quality and to determine whether or not the patient phenomenology could accurately be identified.Results:Of the 20 videos identified, 10 (50%) were determined to be of additional clinical value. In 62.4% of evaluations movement disorders attendings and fellows were able to identify phenomenology from the home videos consistent with the final diagnosis. Videos rated as “poor” quality had significantly lower odds of leading to a correct phenomenology (odd ratio: 0.07, 95% confidence interval [0.01–0.72]) than those rated as “excellent” quality.Conclusions:Patients should be encouraged to produce good quality home videos, particularly in paroxysmal or fluctuating movement disorders, as they may add value to the eventual diagnosis and management.

O-EG003. Can spike voltage topography predict the ictal patterns in temporal lobe epilepsy?

Introduction . To study whether voltage topographic analysis of interictal epileptiform discharges (IEDs) in temporal lobe epilepsy (TLE) help to predict the type of scalp ictal onset pattern. Methods . IEDs from 74 patients with drug resistant TLE and unilateral mesial temporal sclerosis (MTS) who underwent presurgical evaluation were categorized according to dipolar fields into Types A and B temporal IEDs. Type A IEDs were defined as those with dipolar fields (tangential/ vertical) with sharply defined negativity over the infero-lateral temporal scalp and positivity over contra lateral centro-parietal scalp. Type B IEDs included all other IEDs other than Type A. Scalp ictal electrographic patterns were classified into rhythms confined to temporal lobe ipsilateral to MTS (“focal”), lateralized to the hemisphere (“regional”), and diffuse, nonlateralized and non-localized rhythms (“diffuse”) and ictal onset to the contra lateral side of MTS (“discordant”). Results . A total of 5476 IEDs and 377 seizures were analyzed. They were divided into four categories based on the side of MTS: 1) Type A IEDs ipsilateral to MTS (44 patients); 2) bilateral Type A IEDs (16 patients); 3) Type B IEDs ipsilateral and Type A IEDs contra laterally (7 patients); 4) Bilateral type B IEDs (7 patients). In 51 of 60 (85%) patients with Type A IEDs (either ipsilateral and/or bilateral to MTS), the ictal pattern was either focal or regional and only in 9 patients (15%) it was “diffuse”.12 of 14 (86%) patients with either ipsilateral or bilateral Type B IEDs showed a diffuse ictal onset, whereas 2 (14%) showed a contralateral ictal onset. Conclusion . In MTS, Type A IEDs are associated with clearly localized ictal onset and Type B IEDs with diffuse ictal onset. A spikevoltage topographic analysis is sufficient for selection of cases for antero-medial temporal lobe resection. Additional home-video recordings of seizures can rule out psychogenic non-epileptiform events.

Home Recording And Video Selection: Their use In A Low-Resource Setting For Epilepsy Diagnosis

Objective: In management of epilepsy, identification of an epileptic seizure, classification, epilepsy syndromes, and management decisions relies heavily on seizure semiology. However, since most seizures are not witnessed, obtained semiology has its limitations. This study aimed to determine how many patients could successfully submit a home recording of a seizure event and if adapted video compilations would improve epilepsy diagnosis and classification in a low resource setting.
 Methods: A prospective cross-sectional study carried out at a neurology clinic in a teaching hospital in a low-resource setting. Sixty-seven randomly selected patients with recurrent unprovoked seizures and an informant who had regular observed the seizures and had access to video recording facilities were enrolled. Participants were required to fill an interviewer-administered questionnaire, select from a pre-designed video compilation what best described seizure witnessed, then encouraged on acquisition of video recordings at home. In the absence of video electroencephalography, information obtained was compared with a pre-defined algorithm which combined clinical history, physical examination, EEG results and neuro-images. Accuracy and reliability was calculated for different semiological signs and seizure classification.
 Results: Sixty seven patients were recruited comprising of 30 females and 37 male patients. Only eight (12%) participants returned with an adequate home recording of seizure episode. Incorporating video selection with questionnaire obtained description improved accuracy for generalized seizure (0.85 vs 0.79) and focal onset seizure (0.84 vs 0.73). Test-retest reliability on video selections by informants showed kappa coefficients ranging from 0.88 – 1.000. 
 Significance: Home video recording may not be as practical in our environment depending on the setting as adjustments may be required to make it routine. However, selecting videos from pre-selected video compilation may be a viable alternative to improve accuracy.

Video quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study.

The aim of this study was to evaluate the quality of smartphone videos (SVs) of neurologic events in adult epilepsy outpatients. The use of home video recording in patients with neurological disease states is increasing. Experts interpretation of outpatient smartphone videos of seizures and neurological events has demonstrated similar diagnostic accuracy to inpatient video-electroencephalography (EEG) monitoring. A prospective, multicenter cohort study was conducted to evaluate SV quality in patients with paroxysmal neurologic events from August 15, 2015 through August 31, 2018. Epileptic seizures (ESs), psychogenic nonepileptic attacks (PNEAs), and physiologic nonepileptic events (PhysNEEs) were confirmed by video-EEG monitoring. Experts and senior neurology residents blindly viewed cloud-based SVs without clinical information. Quality ratings with regard to technical and operator-driven metrics were provided in responses to a survey. Forty-four patients (31 women, age 45.1years [r=20-82]) were included and 530 SVs were viewed by a mean of seven experts and six residents; one video per patient was reviewed for a mean of 133.8s (r=9-543). In all, 30 patients had PNEAs, 11 had ESs, and three had PhysNEEs. Quality was suitable in 70.8% of SVs (375/530 total views), with 36/44 (81.8%) patient SVs rated as adequate by the majority of reviewers. Accuracy improved with the presence of convulsive features from 72.4% to 98.2% in ESs and from 71.1% to 95.7% in PNEAs. An accurate diagnosis was given by all reviewers (100%) in 11/44 SVs (all PNEAs). Audio was rated as good by 86.2% of reviewers for these SVs compared with 75.4% for the remaining SVs (p=0.01). Lighting was better in SVs associated with high accuracy (p=0.06), but clarity was not (p=0.59). Poor video quality yielded unknown diagnoses in 24.2% of the SVs reviewed. Features hindering diagnosis were limited interactivity, restricted field of view and short video duration. Smartphone video quality is adequate for clinical interpretation in the majority of patients with paroxysmal neurologic events. Quality can be optimized by encouraging interactivity with the patient, adequate duration of the SV, and enlarged field of view during videography. Quality limitations were primarily operational though accuracy remained for SV review of ESs and PNEAs.

How to distinguish seizures from non-epileptic manifestations.

The first and most important step in establishing diagnosis of epilepsy consists of careful history taking from patients and witnesses. The clinical evaluation of the event will lead the indication for further diagnostic tests including e.g. EEG and MRI. Hence, identifying the paroxysmal event as epileptic or non-epileptic is the very first step in the diagnostic process. Paroxysmal events pose a clinical challenge, as these are unpredictable and do not usually occur in the doctor's office. History taking, hunting for witness reports and home-video recordings are the main tools to conclude whether a paroxysmal event is a seizure or not. In this review, we describe the most common differential diagnoses of epileptic seizures, including syncope, psychogenic non-epileptic seizures, as well as a variety of paroxysmal conditions and behaviours of all age groups. Misdiagnosis of non-epileptic events as epilepsy may not only defer the correct diagnosis and treatment but also poses additional risk by prescribing antiepileptic drugs unnecessarily. Moreover, missing the diagnosis of epilepsy implies risk of additional seizures and therefore possibly injuries, sudden death in people with epilepsy, or status epilepticus. Studies have shown that patient and witness accounts are unreliable in a high percentage of cases. Therefore, the core competency of doctors and medical professionals assessing paroxysmal events is knowledge of the clinical features that help define the different aetiologies, thus empowering them to establish the most accurate appraisal of an event. [Published with video sequences].

Movidea: A Software Package for Automatic Video Analysis of Movements in Infants at Risk for Neurodevelopmental Disorders.

Early detecting the presence of neurodevelopmental disorders plays an important role in the effectiveness of the treatment. In this paper, we present a novel tool to extract motion features using single camera video recordings of infants. The Movidea software was developed to allow the operator to track the movement of end-effectors of infants in free moving conditions and extract movement features automatically. Movidea was used by different operators to analyze a set of video recordings and its performance was evaluated. The results showed that Movidea performance did not vary with the operator, and the tracking was also stable in home-video recordings. Even if the setup allowed for a two-dimensional analysis, most of the informative content of the movement was maintained. The reliability of the measures and features extracted, as well as the easiness of use, may boost the uptake of the proposed solution in clinical settings. Movidea overcomes the current limitation in the clinical practice in early detection of neurodevelopmental disorders by providing objective measures based on reliable data, and adds a new tool for the motor analysis of infants through unobtrusive technology.

Self-gratification Habits among Children Under Five Years of Age: A Prospective Cohort Study

Introduction: Self-gratification or masturbation is a normal sexual behaviour; however, masturbation in childhood is less commonly addressed in literature. Aim: To describe the clinical profile of the children diagnosed with self-gratification condition. Materials and Methods: This prospective cohort study recruited all cases diagnosed to have the self-gratification condition presenting to the outpatient clinic in the Department of Paediatric Medicine, Burdwan Medical College, Burdwan, West Bengal, India during the period- January 2014 to December 2019. Diagnosis was made from history, home videotapes and sometimes by direct observation of the act during hospital stay. All relevant data pertaining to demographic characteristics, clinical presentation, investigations and treatment were collected in case sheets and were analysed by simple descriptive statistics. Results: Fifty-four patients were diagnosed to have the condition. Among them, 29 (53.70%) were girls and 25 (46.30%) were boys. The mean age at first symptoms was 20.98±9.31 months (range 3 months to 3 years 4 months). The average age at diagnosis was 26.16±11.35 months (varied from 4 months to 3 years 11 months). The mean frequency of events was 10.31±5.10 times per week, and the mean duration was 9.83±5.98 minutes. Events occurred mostly when children were left alone and bored (n=34, 62.97%). Usual presentations were: rocking in prone position (n=24, 44.44%), intermittent dystonic posturing of the crossed legs (n=23, 42.59%), direct genital manipulation (n=3, 5.56%) and others (n=4, 7.40%)). Two children had been previously misdiagnosed as having definite epilepsy. In 51 cases (94.44%) home videos were available which served as invaluable tools allowing confident diagnosis. Results of urine and stool examination were normal. MRI and EEG performed on two children with suspected epilepsy were reported normal, and antiepileptic drugs were stopped in both. Sixteen children (29.63%) were sent for behavioural therapy and all of them responded well in next one year. Conclusion: Gratification habits are not uncommon in children and should be considered in the differential diagnosis of epilepsy and other paroxysmal events in early childhood. Home video recording of these actions can be a very influential mean to help in diagnosis and to avoid needless investigations and treatments.

Validity of General Movement Assessment Based on Clinical and Home Videos.

The purposes of this study were to develop an instructional leaflet on home video recording for the General Movement Assessment (GMA) and to examine the concurrent and predictive validity of the GMA completed by physical therapists (PTs) and completed by parents. The GMA and the Alberta Infant Motor Scale (AIMS) were completed by PTs in the clinic. Parents completed the GMA following the instructional leaflet. The content validity of the leaflet was 0.83. The consistency of the GMA results between sources was κ = 0.869. The concurrent validity of the GMA at a corrected age of 3 months was κ = 0.266 (PT) versus 0.525 (parent) using the 10th-percentile cutoffs of the AIMS. The positive likelihood ratio was 26 (PT) versus 25 (parents) at a corrected age of 12 months based on 5th-percentile cutoffs of the AIMS. Home GMA videos are valid for clinical assessment following the instructional leaflet.

Spectrum of Nonepileptic Paroxysmal Events in Children from Southern India.

Background Nonepileptic paroxysmal events (NEPEs) present with episodes similar to epileptic seizures but without abnormal electrical discharge on electroencephalogram (EEG). NEPEs are commonly misdiagnosed as epilepsy. Epilepsy is diagnosed on the basis of a detailed history and examination. Emphasis during history to rule out the possibility of NEPE is important. The wrong diagnosis of epilepsy can lead to physical, psychological, and financial harm to the child and the family. Hence, this study was planned. Objective The objective of the study is to evaluate clinical profile, frequency, and spectrum of NEPE in children. Materials and Methods This is a prospective observational study. Patients with NEPE between January 2014 and August 2016 aged < 18 years were enrolled. NEPEs were diagnosed on the basis of history, home video, and EEG recordings. Patients were divided into different categories according to age, specific type of disorder, and system responsible. Patients were followed for their NEPE frequency and outcome. Results A total of 3,660 children presented with paroxysmal events; of them 8% were diagnosed with NEPE. Patients diagnosed with NEPE were classified into three age groups on the basis of their age of onset of symptom; of the total 285 patients, there were 2 neonates (0.7%), 160 infants (56%), and 123 children and adolescents (43.1%). Fifty-eight percent patients were boys. The most common diagnoses were breath-holding spells 113 (39%), followed by syncope 38 (13.3%) and psychogenic nonepileptic seizures 37 (12.9%). About 9 and 5% of patients had concomitant epilepsy and developmental delay, respectively. Conclusions NEPEs account for 8% of paroxysmal events. Most common NEPEs were breath-holding spells among infants and syncope and “psychogenic nonepileptic seizures” in children and adolescents.

Insights into sleep-related hyper-motor epilepsy: an Egyptian case series

ABSTRACTObjective: Sleep-related hypermotor epilepsy (SHE) is a sleep-related focal epilepsy which is often misdiagnosed. Despite active pharmacological therapy in the management of this disorder, satisfactory seizure control still cannot be achieved. Therefore, the aim of the present study was to identify this disorder among people who were seeking medical advice at Cairo University Epilepsy Unit (CUEU), characterizing its clinical, electroencephalographic and imaging features besides identifying possible indicators of inadequate seizure control on drug-therapy.Patients and methods: This study was carried out on 26 patients with SHE who were subjected to detailed history taking and examination in addition to home video recording, video electroencephalographic (EEG) monitoring and brain imaging. Ictal semiology and EEGs were reviewed and analyzed by experienced neurologists.Results: SHE is an uncommon sleep-related focal epilepsy. In our series, median age of the patients was 18.5 years. It is characterized by being sporadic, with often frontal lobe seizure onset (14/26, 53.8%) and with occasional occurrence in wakefulness. Adolescence age at disease onset (11 years, 6–15), duration less than 1 min, clustering, lack of auras and often uninformative brain imaging (22/25, 88%) are all documented features. Moreover, it has a relatively poor outcome on pharmacological therapy (16/26, 61.5%). Longer disease duration (>4.5 years) was a significant feature of the patients exhibiting inadequate seizure control.Conclusions: Our data show relatively poor prognosis of SHE on medical therapy. Its outcome is significantly related to disease duration at the time of diagnosis.Abbreviation: SHE = Sleep related hypermotor epilepsy