Non-Epileptic Paroxysmal Events in Children

September 3, 2019
It's easy to confuse non-epileptic paroxysmal events in children with epileptic attacks. However, they're actually much more frequent.

Non-epileptic paroxysmal events in children are a group of recurring disorders. These events appear suddenly and last just a short period of time. The disorders are much more frequent than epilepsy, although they’re much less known.

Their prevalence is between 5 and 20% in children. Approximately 10 in every 100 children or adolescents suffer from some sort of non-epileptic paroxysmal event in their lives.

It’s important to know the differences that exist between these events and other disorders. For example, epileptic seizures or febrile seizures. Early diagnosis is key in order to investigate their cause and avoid unnecessary treatments. Learn more about non-epileptic paroxysmal events in today’s article.

The classification of paroxysmal events

Paroxysmal events can be epileptic or non-epileptic. However, today we’ll be focusing solely on the non-epileptic type in order to discuss them in greater detail.

As mentioned above, non-epileptic paroxysmal disorders are a group of diverse disorders produced by brain dysfunctions. They’re unique in that they aren’t the result of neural hyperactivity, as is the case of epileptic disorders.

There are several classes of non-epileptic paroxysmal events, which vary in their clinical manifestations:

  • Cerebral hypoxia. This is the most common type. Cerebral hypoxia involves a temporary loss of consciousness due to a reduction in cerebral blood flow.
Paroxysmal events.

  • Paroxysmal sleep disorders. In general, these disorders are benign in nature.
    • Narcolepsy or cataplexy.
    • Sleepwalking.
    • Obstructive sleep apnea (OSA).
    • Night terrors.
    • Nightmares.
    • Rhythmic movements in the transition in and out of sleep.
  • Non-epileptic paroxysmal motor disorders. Brusk and involuntary movements characterize this type.
    • Infant benign myoclonus.
    • Benign paroxysmal torticollis of infancy.
    • Benign childhood paroxysmal eye deviation.
    • Sandifer syndrome.
    • Spasmus nutans.
    • Ticks.
    • Cramping.
    • Hyperekplexia.
    • Iatrogenic dyskinesias.
    • Neonatal shudders.
    • Stereotypes and motor arrhythmias.
  • Secondary to systemic diseases.
    • Respiratory.
    • Cardiac.
    • Digestive.
    • Metabolic.
    • From drugs or pharmaceuticals.
  • Psychological or psychiatric. These occur especially during adolescence and are more and more frequent.
    • Tantrums.
    • Panic attacks and anxiety.
    • Hyperventilation.
    • Pseudo-crisis.
    • Self-stimulation.
  • Others.

As you can see, there are a wide variety of non-epileptic paroxysmal events. Most likely, you’ve heard of many of these events individually. However, in order to better understand their causes, it’s good to know they all fall into the same group. In general, they’re all of a benign nature.

Diagnosis

Diagnosis is a very important point when it comes to these events. First of all, it allows us to avoid many unnecessary anti-epileptic treatments. Furthermore, it saves us from the distress that often arises in the case of a diagnosis of epilepsy.

Girl with paroxysmal event.

To make a proper diagnosis of these disorders, it’s important to make a detailed study of the patient’s medical history. What’s more, specialists will need to carefully observe the paroxysmal events.

On occasion, some symptoms can make a differential diagnosis complicated. These include, for example:

  • An alteration in levels of consciousness.
  • Abnormal movements.
  • The abrupt and sudden appearance of these events with no warning signs.

Many times, errors in diagnosis are the result of a lack of knowledge about these disorders. At the same time, errors may also have to do with the overvaluation of a family medical history of epilepsy, for example. A history of febrile seizures may also lead to misdiagnosis.

A physical or neurological exploration will also aid in ruling out other pathologies. Sometimes it’s necessary to resort to complementary testing, such as an electroencephalogram (EEG). Other tests that may prove helpful include.

  • Cardiological studies.
  • Psychiatric studies.
  • Neuroimaging.
  • Sleep studies.
  • Hormonal studies.

Treatment

Once a precise diagnosis is made, treatment will depend on the specific type of event and the cause behind its appearance. In most cases, treatment isn’t even necessary.

In general, knowing what’s really going on in order to rule out epilepsy, dissipate fears and normalize situations is enough.

  • Delgado, F. M., Gimeno, A. M., & Muela, S. H. (2008). Episodios paroxísticos no epilépticos. In Asociación Española de Pediatría. Protocolos diagnósticos de Neurología Pediátrica (pp. 66-70). AEP Madrid.
  • Fernández, J. H. (2011). Trastornos paroxísticos no epilépticos. PediatríaIntegral, 857.
  • Sánchez-García S, García Campos O, Verdú Pérez A, Villaizán Pérez C. (2014). Episodios paroxísticos no epilépticos. Form Act Pediatr Aten Prim, 7, (187-93).