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!

• Arrhythmias
  • Long QT and torsades
  • VTach
  • Anytime there is poor cardiac output impairing cerebral perfusion, you can see motor activity / hypoxic convulsions.
• Breath-Holding Spells
  • Actually not associated with inspiratory hold. The child typically screams/cries and exhales fully.
  • They can loose postural tone and have motor activity.
  • Up to 15% will have generalize hypoxic convulsions. (DiMario, 2001)
• Syncope
  • Commonly encountered in teenagers
  • May have eye-rolling, incontinence, and motor twitching.
  • There are many causes of syncope (don’t forget the pregnancy test!) to consider… like Hair Grooming Syncope.
• Sandifer Syndrome
  • Gastroesophageal reflux may cause generalized stiffness or posturing.
  • Can have apnea also.
  • Often occurs 20-30 min after a meal.
• Dystonic Reactions
  • Always look at the medication list!!
• Migraine Syndromes
  • Basilar Migraine
  • Familial Hemiplegic Migraine
• Sleep-Related Phenomena
  • Benign sleep myoclonus
  • Periodic sleep jerks
  • Narcolepsy

Moral of the Morsel:

NOT ALL THAT SHAKES IS A SEIZURE!

 

References