Paroxysmal Events In Children Research Articles

The utility of mobile telephone-recorded videos as adjuncts to the diagnosis of seizures and paroxysmal events in children with suspected epileptic seizures

Epilepsy is often diagnosed through clinical description, but inter-observer interpretations can be diverse and misleading. To assess the utility of smartphone videos in the diagnosis of paediatric epilepsy. The literature was reviewed for evidence to support the use of smartphone videos, inclusive of advantages, ethical practice and potential disadvantages. An existing adult-based quality of video (QOV) scoring tool was adapted for use in children. A pilot study used convenience sampling of videos from 25 patients, which were reviewed to assess the viability of the adapted QOV tool against the subsequent diagnosis for the patients with videos. The referral mechanism of the videos was reviewed for the source and consent processes followed. A total of 14 studies were identified. Methodologies varied; only three focused on videos of children, and QOV was formally scored in three. Studies found that smartphone videos of good quality assisted the differentiation of epilepsy from non-epileptic events, especially with accompanying history and with more experienced clinicians. The ethics and risks of circulation of smartphone videos were briefly considered in a minority of the reports. The pilot study found that the adapted QOV tool correlated with videos of moderate and high quality and subsequent diagnostic closure. Data relating to the role of smartphone video of events in children is lacking, especially from low- and middle-income settings. Guidelines for caregivers to acquire good-quality videos are not part of routine practice. The ethical implications of transfer of sensitive material have not been adequately addressed for this group. Prospective multicentre studies are needed to formally assess the viability of the adapted QOV tool for paediatric videos.

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.

Effectiveness Oral Theophylline, Piracetam, and Iron Treatments in Children With Simple Breath-Holding Spells.

Breath-holding spells (BHS) are common nonepileptic paroxysmal events in children. This is a retrospective study to compare the effectiveness of oral theophylline, piracetam, and iron treatments in children with simple BHS. A total of 146 children (75 girls and 71 boys) with simple BHS were included to this retrospective study. Children were divided into 4 groups: nontreated (no anemia and no treatment), oral theophylline (10 mg/kg/d as a single daily dose), piracetam (40 mg/kg/d in 2 divided doses), and elementary iron (3 mg/kg/d as a single daily dose) treatments. Iron therapy had been given only in children with iron deficiency anemia. Neurologic, cardiologic, and biochemical evaluations were performed for all children. The majority of the patients had cyanotic spells (83.6%). The frequency of attacks/month was markedly decreased with iron (58.8%) and theophylline (82.9%) treatments, but not with piracetam therapy (8.8%) and nontreated group (4.7%). Satisfaction of the parents/caregivers was found to be high in the theophylline group (P < .001). Our results showed that theophylline was the most effective therapy to decrease the frequency of simple BHS in children.

Paroxysmal nonepileptic events in children with epilepsy

ObjectiveThe aim of this study was to clarify the characteristics of paroxysmal nonepileptic events (PNEs) suspected as being epileptic seizures by families of children with epilepsy. MethodsThe video-EEG (vEEG) recordings of habitual paroxysmal events in children with epilepsy at Nagoya University Hospital between October 2006 and January 2016 were reviewed. Based on the doctor’s suspicion before the vEEG, the PNEs were divided into two groups that included PNEs suspected as epileptic seizures and PNEs suspected as PNEs. PNEs in the former group were classified based on the suspected seizure type. ResultsOf 886 habitual paroxysmal events, vEEG confirmed that 83 events (68 children) were PNEs. The median age of the 68 children was 3.2 years. Concurrent epilepsies included focal epilepsies (n=33), infantile spasms (n=16), and other types (n=19). The most common types of PNEs were sleep myoclonus (n=11), followed by stereotypies (n=9), awake myoclonus (n=8), paroxysmal ocular deviations (PODs, n=8), and tonic posturing (n=8). Even after direct observation or video viewing, the doctors suspected epileptic seizures in all three of the PODs and two of the tonic posturing children. Before the vEEG, however, the accurate visual information led to the speculation that the four psychogenic and two sleep myoclonus events were all PNEs. Myoclonus, stereotypies, and head drops were often misdiagnosed as epileptic spasms, while PODs and tonic posturing were often misdiagnosed as focal seizures with motor components. Additionally, staring and motion arrest during a drowsy state were often misdiagnosed as focal dyscognitive seizures. Seven of eight patients with PODs had epileptic spasms that were concurrent with epileptic seizures. A diffuse cerebral lesion or reduced visual acuity was seen in seven patients with PODs. ConclusionWe re-emphasize that vEEG is essential for accurate diagnosis and provides evidence for listing POD in the differential diagnosis of oculomotor paroxysmal events.

Day dreaming and childhood preoccupation

All doctors caring for children with paroxysmal disorders know that an important differential diagnosis for absence seizures (both typical in the ‘normal’ child and atypical in the child with neurodevelopmental problems) and to a lesser extent complex focal seizures is daydreaming and childhood preoccupation. Indeed when, in preparation for writing this report, I audited over a four month period those children referred for ‘blank episodes’ and similar concerns to my rapid access epilepsy clinic where I see patients with suspected new-onset seizures, I made a diagnosis of epilepsy in 5 cases and of probable day dreaming / childhood preoccupation in another 5. However, with the exception of brief references to daydreaming/preoccupation in textbooks, usually in the context of considering the differential diagnosis of typical absence seizures, there is virtually nothing published on this subject. A Medline search of ‘day dreams’, ‘day dreaming’ and ‘preoccupation’ yields very few hits and none are relevant to the consideration of the differential diagnosis of paroxysmal events in children. What follows, therefore, is personal opinion, albeit from a clinician who has a special interest in absence seizures in children.

Assessment of both serum S-100B protein and neuropeptide-Y levels in childhood breath-holding spells

Breath-holding spells are common paroxysmal events in children. Although the spells have a benign prognosis in the long term, they may be complicated by loss of consciousness, tonic-clonic movements, and occasionally seizures. Hence, this study aimed to measure the levels of serum S-100B proteins and neuropeptide-Y in the blood of children who experience breath-holding spells. The study groups consisted of 45 patients (13 females, 32 males) with breath-holding spells and a control group of 32 healthy individuals (12 females, 20 males). The serum S-100B levels were measured using commercially available ELISA kits. The neuropeptide-Y levels in the serum were measured with RayBio® Human/Mouse/Rat Neuropeptide Y ELISA kits. The mean serum S-100B protein level of the breath-holding spells group was 56.38 ± 13.26 pg/mL, and of the control group, 48.53 ± 16.77 pg/mL. The mean neuropeptide-Y level was 62.29 ± 13.89 pg/mL in the breath-holding spells group and 58.24 ± 12.30 pg/mL in the control group. There were significant differences between the groups with respect to serum S-100B protein levels (p = 0.025), while there was no statistically significant difference in neuropeptide-Y levels between the breath-holding spells group and the control group (p = 0.192). The findings of this study suggest that frequent and lengthy breath-holding may lead to the development of neuronal metabolic dysfunction or neuronal damage which is most likely related to hypoxia. In light of these findings, future studies should be conducted using biochemical and radiological imaging techniques to support these results.

PP14.6 – 2304: Assessment of both the serum S-100B protein and neuropeptide Y levels in childhood breath-holding spells

Objective Breath-holding spells are common paroxysmal events in children. Although the spells have a benign prognosis in the long term, they may be complicated by loss of consciousness, tonic-clonic movements, and occasionally, seizures. To the best of our knowledge, there have been no studies investigating whether attacks of breath-holding spells may lead to neuronal damage. In addition, the neurotransmitters and neuropeptides related to seizures have not been previously measured in breath-holding spells. This study aimed to measure the levels of serum S-100B proteins and neuropeptide-Y in the blood of children who experience breath-holding spells. Methods This prospective study was performed at the Department of Pediatric Neurology, Harran University School of Medicine, Sanliurfa, in Turkey. The study groups consisted of 45 patients (13 females, 32 males) with breath-holding spells and a control group of 32 healthy individuals (12 females, 20 males). The serum S-100B levels were measured by using commercially available ELISA kits and The neuropeptide-Y levels in the serum was measured with RayBio® Human/Mouse/Rat Neuropeptide Y ELISA kits. Results There were significant differences between the groups regarding to serum S-100B protein levels (P=0.025), while there was no statistically significant difference in neuropeptide-Y levels between the breath-holding spells group and control group (P=0.192). Conclusions In conclusion, frequent or lengthy breath-holding spells may lead to the development of neuronal damage which s most likely secondary to hypoxia. Therefore, breath-holding spells should be taken under the control as soon as possible.

Non-epileptic paroxysmal events mimicking seizures.

The diagnosis of epilepsy rests on a detailed history and examination. The main focus of such a history is to exclude the possibility of non-epileptic paroxysmal events. An incorrect diagnosis of epilepsy can potentially lead to physical, psychological and financial harm to the child and the family. A wide range of non-epileptic paroxysmal events can occur in children. The differentiation of a seizure mimic from a seizure relies solely on a proper history and review of video recordings. Investigations rarely help in the diagnosis of these events. An early and timely diagnosis and proper parental counseling helps avoiding unnecessary investigations, treatment and allays parental anxiety. The article reviews the common non-epileptic paroxysmal events in children, emphasizing clinically relevant points.

Nonepileptic paroxysmal events in a pediatric population

Nonepileptic paroxysmal events in children are common, and may be more diverse in etiology than those seen in adults. We determined the types of nonepileptic events that are most prominent in the pediatric population, and stratified those events by age group. Ninety-four of 416 pediatric patients monitored during a 3-year period (23%) were found to have had nonepileptic events. Thirty-eight percent of these children were diagnosed with psychogenic nonepileptic seizures, and 72% of those were adolescents. In children younger than 5 years of age, behavioral events and parasomnias were the most common mimickers of epilepsy. Other events, including stereotyped movements and myoclonus, were also diagnosed. We suggest that children with refractory paroxysmal events should be considered for early inpatient monitoring.

Expanding Spectrum of Paroxysmal Events in Children: Potential Mimickers of Epilepsy

Paroxysmal events in children can mimic epileptic seizures, and many of them have only been recently described, or are only now being increasingly recognized. An awareness of the different mimickers of epilepsy and the art of history-taking will help pediatricians and neurologists differentiate epileptic from nonepileptic events. Nonepileptic paroxysms can present with drop attacks, limb or eye jerks, and abnormal postures. This review describes the different mimickers of epilepsy and focuses on their circumstances, precipitators, prodromes, pathophysiology, and other manifestations that help distinguish them from epilepsy.

The accuracy of the diagnosis of paroxysmal events in children.

To assess the accuracy of the diagnosis of epileptic seizures in children. The Dutch Study of Epilepsy in Childhood is a prospective hospital-based study of 881 children referred because of possible seizures. The diagnosis was based on predefined descriptive criteria, as applied by a panel of three pediatric neurologists. Children with a definite other diagnosis were excluded. All children with unclear events were followed up for 1 year and children with seizures were followed up for 2 years to assess the accuracy of the diagnosis. In 170 of 224 children seen after a single event, the incident was classified initially as epileptic, in 54 as unclear. In none of the 170 children did the diagnosis prove to be wrong. In four of the 54 children, recurrent episodes enabled a definite diagnosis of epilepsy. In 412 of the 536 children seen with multiple events, an initial diagnosis of epilepsy was made. After follow-up, this initial diagnosis was probably incorrect in 19. In contrast, seven of 124 children with multiple unclear episodes at intake later received the diagnosis epilepsy. A false-positive diagnosis of epilepsy was made in 4.6%, whereas a definite diagnosis of epilepsy or seizure was delayed in 5.6% of children with multiple unclear events and in 7.4% of children with one unclear event.

Video‐EEG in the diagnosis of paroxysmal events in children with mental retardation and in children with normal intelligence

Video‐EEG monitoring was performed to evaluate 193 children (91 females, 102 males; mean age 9.6 years, SD 5.7) who presented with paroxysmal events of uncertain etiology. Diagnosis of the type of event, i.e. epileptic or non‐epileptic, was successfully established in 130 of 193 patients (67.3%). Seventy children (36%) had mental retardation (MR). Children with MR were more likely (p&lt;0.05) than children without MR to have events during the studies. Children with and without MR had strikingly similar frequencies of epileptic and non‐epileptic events. In participants who had events recorded and characterized, epileptic seizures were identified in 67 children (51.5%), non‐epileptic events in 54 children (41.5%), and both epileptic and non‐epileptic events in nine children (7%). Improved diagnosis prompted appropriate management. This should encourage more frequent use of video‐EEG in children, especially in those with MR, to differentiate epilepsy from behavioral disturbances so that specific treatment can be provided.

Video-EEG in the diagnosis of paroxysmal events in children with mental retardation and in children with normal intelligence.

Video-EEG monitoring was performed to evaluate 193 children (91 females, 102 males; mean age 9.6 years, SD 5.7) who presented with paroxysmal events of uncertain etiology. Diagnosis of the type of event, i.e. epileptic or non-epileptic, was successfully established in 130 of 193 patients (67.3%). Seventy children (36%) had mental retardation* (MR). Children with MR were more likely (p<0.05) than children without MR to have events during the studies. Children with and without MR had strikingly similar frequencies of epileptic and non-epileptic events. In participants who had events recorded and characterized, epileptic seizures were identified in 67 children (51.5%), non-epileptic events in 54 children (41.5%), and both epileptic and non-epileptic events in nine children (7%). Improved diagnosis prompted appropriate management. This should encourage more frequent use of video-EEG in children, especially in those with MR, to differentiate epilepsy from behavioral disturbances so that specific treatment can be provided.