Paroxysmal nonepileptic events in children with epilepsy.
The aim of this study was to clarify the characteristics of paroxysmal nonepileptic events (PNEs) suspected as being epileptic seizures by families of children with epilepsy.



The video-EEG (vEEG) recordings of habitual paroxysmal events in children with epilepsy at Nagoya University Hospital between October 2006 and January 2016 were reviewed. Based on the doctor's suspicion before the vEEG, the PNEs were divided into two groups that included PNEs suspected as epileptic seizures and PNEs suspected as PNEs. PNEs in the former group were classified based on the suspected seizure type.



Of 886 habitual paroxysmal events, vEEG confirmed that 83 events (68 children) were PNEs. The median age of the 68 children was 3.2 years. Concurrent epilepsies included focal epilepsies (n=33), infantile spasms (n=16), and other types (n=19). The most common types of PNEs were sleep myoclonus (n=11), followed by stereotypies (n=9), awake myoclonus (n=8), paroxysmal ocular deviations (PODs, n=8), and tonic posturing (n=8). Even after direct observation or video viewing, the doctors suspected epileptic seizures in all three of the PODs and two of the tonic posturing children. Before the vEEG, however, the accurate visual information led to the speculation that the four psychogenic and two sleep myoclonus events were all PNEs. Myoclonus, stereotypies, and head drops were often misdiagnosed as epileptic spasms, while PODs and tonic posturing were often misdiagnosed as focal seizures with motor components. Additionally, staring and motion arrest during a drowsy state were often misdiagnosed as focal dyscognitive seizures. Seven of eight patients with PODs had epileptic spasms that were concurrent with epileptic seizures. A diffuse cerebral lesion or reduced visual acuity was seen in seven patients with PODs.



We re-emphasize that vEEG is essential for accurate diagnosis and provides evidence for listing POD in the differential diagnosis of oculomotor paroxysmal events.
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan; Brain & Mind Research Center, Nagoya University, Aichi, Japan.
Yuji
Y
Ito
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan; Brain & Mind Research Center, Nagoya University, Aichi, Japan.
Hiroyuki
H
Kidokoro
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Tamiko
T
Negoro
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Masaharu
M
Tanaka
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Yu
Y
Okai
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Yoko
Y
Sakaguchi
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Chikako
C
Ogawa
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Tomoya
T
Takeuchi
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Atsuko
A
Ohno
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Hiroyuki
H
Yamamoto
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Tomohiko
T
Nakata
Brain & Mind Research Center, Nagoya University, Aichi, Japan.
Satoshi
S
Maesawa
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Kazuyoshi
K
Watanabe
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
Yoshiyuki
Y
Takahashi
Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan; Brain & Mind Research Center, Nagoya University, Aichi, Japan. Electronic address: junnatsu@med.nagoya-u.ac.jp.
Jun
J
Natsume
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000503:physiopathology; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis / Q000503:physiopathology; D012890:Sleep / Q000502:physiology; D014741:Video Recording / Q000379:methods
Childhood; Nonepileptic seizures; Paroxysmal ocular deviation; Video-EEG