Common childhood epilepsy mimics

Abstract

Unusual movements in children frequently generate concern of underlying seizures from parents and lead to professional review. Stigma associated with epilepsy heightens anxiety and a wish to confirm or exclude the diagnosis as soon as possible. These considerations could lead to a wrong diagnosis of epilepsy being given with unwarranted exposure to medications with potential side effects and cost burden to families. This chapter seeks to provide practitioners in pediatric epilepsy with an exploration of practical differential diagnoses for epilepsy in children, particularly for convulsive seizures. Evaluation of all epilepsy mimics requires a precise and relevant history to help arrive at a diagnosis. Epilepsy mimics across various ages will be reviewed, with the most common differential diagnoses presented first. Examples of common potential epilepsy mimics include benign sleep myoclonus, which is frequently observed in infants and may be a challenge to differentiate from myoclonic seizures in infants. It is a very common phenomenon in pre-term infants with an incidence of 57-132 per 1000 live births. Breath-holding spells among toddlers are common and may be mistaken for epilepsy, as can reflex anoxic seizures. Self-gratification phenomena have been observed from infancy onward and may resemble clonic seizures. Inattention in school-going children is a differential diagnosis for absence seizures and both conditions may co-exist. Stressed or traumatized children may present with non-epileptic psychogenic seizures, as can children with established seizures. Lack of concurrent electrophysiological correlates and absence of stereotypic presentation help differentiate inattention and non-epileptic seizures from childhood epilepsy. Sleep-related activity such as hallucinations, parasomnias, and hypnagogic jerks could also be mistaken for epilepsy in children. Video electroencephalogram (video-EEG) telemetry evaluation is invaluable in such cases. Lack of video-EEG services, simple videos, or EEG studies in resource-poor settings makes diagnosis of epilepsy imitators challenging. The differences between epilepsy and common differential diagnoses for practitioners in resource-limited settings who may lack access to requisite investigative tools will be addressed in the following text. The outcome for most epilepsy mimics is excellent with minimal morbidity and mortality. The potential danger posed by unnecessary medical interventions caused by misdiagnosis of epilepsy makes it imperative that this possibility is minimized.