Paroxysmal nonepileptic events in children with epilepsy

Yuji Ito, Hiroyuki Kidokoro, Tamiko Negoro, Masaharu Tanaka, Yu Okai, Yoko Sakaguchi, Chikako Ogawa, Tomoya Takeuchi, Atsuko Ohno, Hiroyuki Yamamoto, Tomohiko Nakata, Satoshi Maesawa, Kazuyoshi Watanabe, Yoshiyuki Takahashi, Jun Natsume.  Paroxysmal nonepileptic events in children with epilepsy.  Epilepsy Research.   Volume 132, Pages 59–63. http://www.epires-journal.com/article/S0920-1211(17)30012-8/fulltext?rss=yes

 Highlights

•Common types of PNEs are myoclonus, stereotypies, and paroxysmal ocular deviations.

•Myoclonus and stereotypies are often misdiagnosed as epileptic spasms.

•Paroxysmal ocular deviations are misdiagnosed as focal seizures or epileptic spasms.

•Paroxysmal ocular deviations are related to visual acuity and diffuse brain lesions.

Abstract

Objective

The 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.

Methods

The 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.

Results

Of 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.

Conclusion

We re-emphasize that vEEG is essential for accurate diagnosis and provides evidence for listing POD in the differential diagnosis of oculomotor paroxysmal events.

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The clinicians planned a study to elucidate the characteristics of paroxysmal nonepileptic events (PNEs) suspected as being epileptic seizures by families of children with epilepsy. They re–emphasize that for accurate diagnosis, video–EEG (vEEG) is essential and provides evidence for listing paroxysmal ocular deviation (POD) in the differential diagnosis of oculomotor paroxysmal events.

Methods

Between October 2006 and January 2016, the clinicians reviewed the video-EEG (vEEG) recordings of habitual paroxysmal events in children with epilepsy at Nagoya University Hospital.

The PNEs were divided into two groups that included PNEs suspected as epileptic seizures and PNEs suspected as PNEs based on the doctor’s suspicion before the vEEG.

Based on the suspected seizure type, PNEs in the former group were classified.

Results

In this study, vEEG confirmed that 83 events (68 children) were PNEs, out of 886 habitual paroxysmal events.

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).

Sleep myoclonus (n = 11) were the most common types of PNEs, followed by stereotypies (n = 9), awake myoclonus (n = 8), paroxysmal ocular deviations (PODs, n = 8), and tonic posturing (n = 8).

The doctors suspected epileptic seizures in all 3 of the PODs and 2 of the tonic posturing children even after direct observation or video viewing.

However, before the vEEG, the accurate visual information led to the speculation that the 4 psychogenic and 2 sleep myoclonus events were all PNEs.

While PODs and tonic posturing were often misdiagnosed as focal seizures with motor components, myoclonus, stereotypies, and head drops were often misdiagnosed as epileptic spasms.

Also, staring and motion arrest were often misdiagnosed as focal dyscognitive seizures during a drowsy state.

7 /8 patients with PODs had epileptic spasms that were concurrent with epileptic seizures.

The study observed a diffuse cerebral lesion or reduced visual acuity in 7 patients with PODs.

https://www.mdlinx.com/neurology/medical-news-article/2017/03/17/childhood-nonepileptic-seizures-paroxysmal-ocular-deviation/7079073/?category=latest&page_id=1