John Libbey Eurotext

How to distinguish seizures from non-epileptic manifestations Volume 22, numéro 6, December 2020

Self-gratification. A 14-month-old girl, with normal development, showing stiffening with tonic extension and scissoring of lower limbs with repetitive rocking movements.

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How to distinguish seizures from non-epileptic manifestations Hyperekplexia. A 10-day-old term newborn patient (formerly published by Eisermann et al. [2014] for another unpublished sequence), presenting with massive and sustained stiffening of the trunk and limbs, clenching of the fists, crying with trembling of the voice, and facial cyanosis due to prolonged apnoea, triggered by auditory (hand clapping) stimulation, which ceased spontaneously. The polygraphic video-EEG discloses diffuse movement and muscular artefacts without underlying tonic discharge or post-event background modification.

How to distinguish seizures from non-epileptic manifestations Jitteriness. A two-month-old boy, born at term, with congenital heart disease (ventricular septal defect associated with coarctation of aorta) who received surgery at one month of age, is seen with spontaneous episodes of diffuse tremor movements, predominating on lower limbs, immediately and completely stopped by restraining the left leg.

How to distinguish seizures from non-epileptic manifestations Benign neonatal sleep myoclonus. Home video of a seven-day-old healthy-term newborn, presenting withmyoclonic jerks, isolated or in clusters of 2-4, affecting the four limbs during a quiet sleep period.

How to distinguish seizures from non-epileptic manifestations Psychogenic non-epileptic seizures (PNES). A 12-year-old boy with frequent episodes of falling, jerks and apparent loss of consciousness. Clinical and video-EEG data confirmed the suspicion of a psychogenic origin. Both the jerks (A, B) and the fall (C) are clearly recognizable as non-epileptic manifestations.

How to distinguish seizures from non-epileptic manifestations Disorders of arousal (DOA). Confusional arousal (Patient 1) A video-PSG documenting confusional arousal in a six-year-old child. The child appears to wake up but is disoriented and confused. He says some unintelligible words and when asked where he is, he answers “in Egypt” (00.56”). The episode occurs in NREM sleep (Stage N3). Notice the persistence of slow waves on the EEG during movements and while he is speaking. Sleep terrors (Patient 2) A 30-year-old patient, recorded in the video-PSG laboratory, suffering from numerous (multi-weekly) episodes of nocturnal agitation after which, in the morning, she had no memory of. The video documents a short episode characterized by abrupt awakening, with a scream followed by unintelligible words (as if she were talking to someone). The technician turns on the light, enters the room and interrogates her. The patient appears confused, and towards the end she recalls a dream that had probably frightened her. Sleepwalking (Patient 3) A 9-year-old patient with frequent episodes of sleepwalking during the night.We recorded an episode characterized by an apparent awakening followed by exploratory behaviour. At some point, the mother in the room talks to him before he gets out of bed. In the morning, the child remembers nothing of what happened. The episode occurred in Stage N3 sleep, with persistence of slow waves throughout the movement. Sleepwalking, sleep-terrors (Patient 4) Home-video recordings of a 32-year-old patient with frequent episodes of nocturnal ambulation, sometimes accompanied by screaming. The video captured two episodes with different semiological features. In one, he runs towards the light, frightened; in the second, he seems to shake something off his arm (he says: “what the hell were they?”).

How to distinguish seizures from non-epileptic manifestations Alternating hemiplegia. A seven-month-old infant showing an episode with left unilateral horizontal oculoclonic manifestations, preceding a left hemiplegic attack.

How to distinguish seizures from non-epileptic manifestations Shuddering attacks (shuddering and stereotypies). A 14-month-old boy during a period of emotional excitation showing hand and foot stereotypies and numerous brief tonic contractions with shivering movements (lower limbs in extension, upper limbs in flexion), spontaneously or triggered and enhanced by stimulation.

How to distinguish seizures from non-epileptic manifestations Cataplexy. An 11-year-old boy suffering from newly developed narcolepsy-cataplexy, showing partial (head drops while sitting) (A) and full (standing) (B) cataplectic attacks while watching funny videos.