title: Misdiagnosis of gastroesophageal reflux disease as epileptic seizures in children.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) can mimic epileptic seizure, and may be misdiagnosed as epilepsy. On the other hand, GERD can be more commonly seen in children with neurological disorders such as cerebral palsy (CP); this co-incidence may complicate the management of patients by mimicking refractory seizures.
  
  
  OBJECTIVE
  The purpose of our study was to evaluate the clinical features, definite diagnoses and treatment approaches of the patients with clinically suspected GERD who were referred to the division of pediatric neurology with a suspected diagnosis of epileptic seizure. We also aimed to investigate the occurrence of GERD in children with epilepsy and/or CP.
  
  
  METHODS
  Fifty-seven children who had a final diagnosis of GERD but were initially suspected of having epileptic seizures were assessed prospectively.
  
  
  RESULTS
  All patients were assigned to 3 groups according to definite diagnoses as follows: patients with only GERD who were misdiagnosed as having epileptic seizure (group 1: n=16; 28.1%), those with comorbidity of epilepsy and GERD (group 2: n=21; 36.8%), and those with the coexistence of GERD with epilepsy and CP (group 3: n=20; 35.1%). Five patients (8.8%) did not respond to anti-reflux treatment and laparoscopic reflux surgery was performed. The positive effect of GERD therapy on paroxysmal nonepileptic events was observed in 51/57 (89.5%) patients.
  
  
  CONCLUSIONS
  GERD is one of the important causes of paroxysmal nonepileptic events. In addition, GERD must be kept in mind at the initial diagnosis and also in the long-term management of patients with neurological disorders such as epilepsy and CP.
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey. Electronic address: draysebayram@gmail.com.
authors.forename: Ayşe Kaçar
authors.initials: AK
authors.lastname: Bayram
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey. Electronic address: drmehmetcanpolat@gmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Canpolat
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology, Erciyes University, Faculty of Medicine, Kayseri, Turkey. Electronic address: dr.neslihan@yahoo.com.
authors.forename: Neslihan
authors.initials: N
authors.lastname: Karacabey
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey. Electronic address: hakgumus33@yahoo.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Gumus
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey. Electronic address: skumandas@hotmail.com.
authors.forename: Sefer
authors.initials: S
authors.lastname: Kumandas
authors.affiliation: Department of Radiology, Division of Pediatric Radiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey. Electronic address: selimdoganay@gmail.com.
authors.forename: Selim
authors.initials: S
authors.lastname: Doğanay
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology, Erciyes University, Faculty of Medicine, Kayseri, Turkey. Electronic address: duran@erciyes.edu.tr.
authors.forename: Duran
authors.initials: D
authors.lastname: Arslan
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey. Electronic address: huseyinper@yahoo.com.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Per
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D012640:Seizures / Q000175:diagnosis
keywords: Children; Epileptic seizure; Gastroesophageal reflux disease; Misdiagnosis; Paroxysmal nonepileptic events