'Not everything that shakes is epilepsy'. The differential diagnosis of paroxysmal nonepileptiform disorders

Abstract

Many infants, children, and adolescents exhibit unusual mannerisms, behaviors, and spells. These events cause concern to parents and are frequently brought to the attention of physicians. If the spells are infrequent and do not interfere with function, no intervention may be necessary. If they are severe and recurrent, however, diagnostic evaluation is necessary. This article has reviewed the most common spells that can be misdiagnosed as epilepsy by pediatricians. Other spells such as head banging, head rolling, body rocking, enuresis, nightmares, bruxism, obsessions, compulsions, self-injurious behavior, self-stimulating behavior, and stereotypies are reviewed elsewhere. Emphasis is placed on the importance of a thorough history, a complete general physical and neurologic examination, and the judicious use of laboratory testing. The diagnostic methodologies currently available, including cardiac evaluation, video-EEG monitoring, and polysomnography, will frequently result in a specific diagnosis, and allow appropriate treatment. In many cases, however, even after the above diagnostic tests have been utilized, no diagnosis is forthcoming, but reassurance and follow-up can be of help to the young patient and the family.