Clinical Study of Differential Diagnosis between Childhood Convulsive Disorders and Nonepileptic Paroxysmal Disorders / 대한소아신경학회지

ABSTRACT

PURPOSE: Many neurologic and psychiatric behaviors can mimic epileptic seizures. Making a diagnosis of these nonepileptic paroxysmal disorders is very important to prevent inappropriate use of antiepileptic drugs. We studied the clinical characteristics of nonepileptic paroxysmal events in order to help differentiate them from true epileptic seizures. METHODS: We retrospectively reviewed 77 patients aged 2 months-15 years who visited the Pediatric Neurology clinic from January, 1990 to January, 1999 for evaluation of seizure disorders who were diagnosed as having nonepileptic paroxysmal disorders. RESULTS: Nonepileptic paroxysmal disorders were classified into 6 major groups as follows movement disorders 19 cases (23.5%), respiratory disorders 16 (19.8%), loss of consciousness or tone 15 (18.5%), drug-induced dystonia 14 (17.3%), behavioral disorders 12 (14.8%), and perceptual disturbances 5 (6.1%). The final diagnoses of the 6 major groups were as follows breath holding spell 16 cases (19.8%), syncope 14 (17.3%), drug-induced dystonia 14 (17.3%), pseudoseizure 6 (7.4%), sleep disorders 5 (6.1%), tics 4 (4.9%), headache 4 (4.9%), temper tantrum 4 (4.9%), sleep myoclonus 3 (3.7%), paroxysmal choreoathetosis 2 (2.5%), and masturbation 2 (2.5%). Five of the 77 patients also had idiopathic epilepsy. Breath holding spell is common in 2 months-6 years of age, syncope in 2-15 years, and pseudoseizure in 6-15 years. Monitoring in patients with pseudoseizure and abnormal eye movement with video EEG is helpful for diagnosis. CONCLUSION: Nonepileptic neurologic disorders are common and show a different incidence according to age group. The exact diagnosis of nonepileptic paroxysmal disorders using video EEG, is very important for preventing misdiagnosis and inappropriate use of antiepileptic drugs.