Few things will frighten parents more than seeing their child appear to shake all over. Fortunately, many times seizure activity is due to benign causes like simple febrile seizures. Unfortunately, our job is quite difficult and we need to deal with other more troublesome entities like complex febrile seizures or neonatal seizures. Of course we also need to consider entities that may provoke seizures, like hypoglycemia, AVMs, or pyridoxine deficiency. While juggling all of the potential causes of seizures, we also need to pause and ask ourselves a simple question: was this even a seizure? Perhaps we are dealing with a Seizure Mimic!
Seizure Numbers
Seizures are the most common pediatric neurologic emergency.
Seizures affect 4-10% of children during their lifetime. (Hauser, 1994)
~10% of new onset seizures present to the ED in status epileptics. (Singh, 2010)
Some Seizure Mimics
Since seizures are the most common neurologic emergency encountered in pediatric patients, it is reasonable to have it on the Ddx list of any child presenting with odd movements and/or behavior; however, there are also other significant conditions that should be considered in that situation! Here are some that could alter your initial management!
Luat AF, Kamat D, Sivaswamy L. Paroxysmal nonepileptic events in infancy, childhood, and adolescence. Pediatr Ann. 2015 Feb 1;44(2):e18-23. PMID: 25658214. [PubMed] [Read by QxMD]
There are a wide variety of paroxysmal nonepileptic events (PNEEs) in children that can mimic seizures. The type of PNEEs that need to be considered in the differential diagnosis depends on the age of symptom onset and the clinical features. In infants and toddlers, conditions that are relatively common in clinical practice such as apnea, jitteriness, shuddering attacks, and breath-holding spells may not present much of a diagnostic conundrum, wh […]
Agarwal M1, Fox SM. Pediatric seizures. Emerg Med Clin North Am. 2013 Aug;31(3):733-54. PMID: 23915601. [PubMed] [Read by QxMD]
Seizures are a commonly encountered condition within the emergency department and, because of this, can engender complacency on the part of the physicians and staff. Unfortunately, there is significant associated morbidity and mortality with seizures, and they should never be regarded as routine. This point is particularly important with respect to seizures in pediatric patients. The aim of this review is to provide a current view of the various […]
Obeid M1, Mikati MA. Expanding spectrum of paroxysmal events in children: potential mimickers of epilepsy. Pediatr Neurol. 2007 Nov;37(5):309-16. PMID: 17950415. [PubMed] [Read by QxMD]
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 […]
DiMario FJ Jr1. Paroxysmal nonepileptic events of childhood. Semin Pediatr Neurol. 2006 Dec;13(4):208-21. PMID: 17178351. [PubMed] [Read by QxMD]
The paroxysmal nonepileptic events of childhood are a group of disorders, syndromes, and phenomena that mimic true epileptic seizures. Clinical experience and a clear description of the event in question will usually lead to a correct categorization. They span in age from neonate to young adult and are apt to be the most common diagnostic challenges clinicians face regularly. The key to diagnosis is a detailed history and careful observation. Des […]
Hauser WA1. The prevalence and incidence of convulsive disorders in children. Epilepsia. 1994;35 Suppl 2:S1-6. PMID: 8275976. [PubMed] [Read by QxMD]
Each year, about 150,000 children and adolescents in the United States will come to medical attention for evaluation of a newly occurring seizure disorder of some type. Between 2% and 4% of all children in Europe and the United States experience at least one convulsion associated with a febrile illness before the age of 5 years. The cumulative incidence of febrile convulsions among children ranges from about 1% in China to more than 8% in Japan a […]
Sean M. Fox
I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.
[…] occurrence in the Emergency Department. We have discussed seizure related issues in the past: Seizure Mimics, Neonatal Seizures, Simple Febrile Seizures, and Complex Febrile Seizures. Some seizures require […]
[…] Pediatric seizure mimics on Pediatric EM Morsels […]
[…] published at Pediatric EM Morsels on November 28, 2014. Reposted with […]
[…] Pediatric seizure mimics on Pediatric EM Morsels […]
[…] Pediatric seizure mimics on Pediatric EM Morsels […]
[…] even demonstrate seizure-like activity immediately upon loss of […]
[…] occurrence in the Emergency Department. We have discussed seizure related issues in the past: Seizure Mimics, Neonatal Seizures, Simple Febrile Seizures, and Complex Febrile Seizures. Some seizures require […]
[…] Pediatric seizure mimics on Pediatric EM Morsels […]
[…] published at Pediatric EM Morsels on November 28, 2014. Reposted with […]
[…] Pediatric seizure mimics on Pediatric EM Morsels […]
[…] Pediatric seizure mimics on Pediatric EM Morsels […]
[…] even demonstrate seizure-like activity immediately upon loss of […]
[…] Tremors, seizures […]
[…] Seizure Disorders […]