title: Paroxysmal non-epileptic events in infants and toddlers: A phenomenologic analysis.
abstract: OBJECTIVE
  The aim of this study was to analyze in detail the clinical phenomenology of paroxysmal non-epileptic events (PNEE) in infants and toddlers.
  
  
  METHODS
  We studied all children aged ≤2 years who were diagnosed with PNEE based on video-electroencephalographic (VEEG) recordings. We analyzed the following four clinical domains of each clinical event: (i) motor manifestations (body/limb jerking, complex motor, and asymmetric limb posturing); (ii) oral/vocal (crying, vocalization, sighing); (iii) behavioral change (arrest of activity, staring); (iv) and autonomic (facial flushing, breath holding).
  
  
  RESULTS
  Thirty-one of 81 (38.3%) infants and toddlers had 38 PNEE recorded during the study period (12 girls and 19 boys, mean age 10.5 months). The predominant clinical features were as follows: motor in 26/38 events, oral/verbal in 14/38 events, behavioral in 11/38 events, and autonomic in 8/38 events. Epileptic seizures and PNEE coexisted in four children (12.9%). Seventeen children (54.8%) had one or more risk factors suggestive of epilepsy. Twelve children (38.7%) had a normal neurologic examination, 10 (32.3%) had developmental delay, and eight (25.8%) had a family history of epilepsy or seizures.
  
  
  CONCLUSIONS
  VEEG recorded PNEE in nearly 40% of 81 infants and toddlers referred for unclear paroxysmal events in our cohort. Non-epileptic staring spells and benign sleep myoclonus were the most common events recorded, followed by shuddering attacks and infantile masturbation. In addition, greater than one-half of the infants and toddlers had risk factors, raising a concern for epilepsy in the family and prompting the VEEG evaluation, suggesting that paroxysmal non-epileptic seizures may frequently coexist in young children with epilepsy.
authors.affiliation: Neurology Department, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.affiliation: Pediatric Epilepsy Section, Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland, USA.
authors.forename: Elia M Pestana
authors.initials: EM
authors.lastname: Knight
authors.affiliation: Division of Pediatric Epilepsy, Department of Pediatrics, Rainbow Babies and Children's University Hospital, Case Medical Center, Cleveland, USA.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Tuxhorn
authors.affiliation: Division of Pediatric Epilepsy, Department of Pediatrics, Rainbow Babies and Children's University Hospital, Case Medical Center, Cleveland, USA.
authors.forename: Asim
authors.initials: A
authors.lastname: Shahid
authors.affiliation: Epilepsy Center, Neurological Institute, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, USA.
authors.forename: Hans O
authors.initials: HO
authors.lastname: Lüders
mesh_terms: D001143:Arousal; D002675:Child, Preschool; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007231:Infant, Newborn; D008297:Male; D008418:Masturbation / Q000175:diagnosis*; D020189:Nocturnal Myoclonus Syndrome / Q000175:diagnosis*; D012189:Retrospective Studies; D014741:Video Recording
keywords: infants; paroxysmal non-epileptic events; phenomenology; toddlers; video electroencephalography