Seizure Imitators in Pediatric Patients

The terminology on the topic has been variable and confusing. Seizure is from to the verb: seize but may mean different meanings to different people, such as any type of spell, or epileptic seizure.PNES means psychogenic nonepileptic seizure, and it is in contrast with another term: Paroxysmal (both Physiologic and Psychologic) nonepileptic seizure. Strictly speaking, terms like nonepileptic seizures, nonepileptic spells, and nonepileptic events include any episode that mimics epileptic seizures. Paroxysmal Physiologic NonEpileptic Seizures: Neonates, Infants, Toddlers include: Jitteriness, Benign Myoclonus, Head Banging, Body Rocking, Startle Disease or Hyperekplexia, Cyanotic Breath-Holding Spells, Self Gratifiication, Shudderings, and Paroxysmal Vertigo.In Children we face other condition such as: Night Terrors (Pavor Nocturnus) and Nightmares, Sleep walking (Somnambulism) and sleep talking (Somniloquy), Tics, Chorea, Staring Spells (Daydreaming), Stereotypic Movements, Rage Attacks (Episodic Dyscontrol Syndrome) Munchausen Syndrome by Proxy, and Recurrent Abdominal Pain and in the adolescents still other conditions are more common. Some of them are as follows: Syncope, Narcolepsy and Cataplexy, Basilar Migraine, Confusional Migraine, Tremor, and Panic Disorders.PNESs, as the focus of this discussion, resemble epileptic seizures and present as a sudden, involuntary, time-limited alteration in behavior, motor activity, autonomic function, consciousness, or sensation. However, unlike epilepsy, PNESs do not result from epileptogenic pathology and are not accompanied by an epileptiform electrographic ictal pattern. PNESs comprise ۳۰% of all paroxysmal nonepileptic events in children.Unfortunately, once the diagnosis of “seizures” is made, it is easily perpetuated without being questioned and is difficult to undo, which explains the usual diagnostic delay in differentiating non-seizure and non-epileptic events from true epileptic seizures. One of the key clues to think about seizure-mimickers in the first step could be resistance to many antiepileptic drugs.In this brief review, different conditions in children that may mimic epileptic seizures will be discussed and illustrated better with showing video clips of them.