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Nonepileptic paroxysmal disorders in infancy

Thien T Nguyen, MD, PhD
Peter W Kaplan, MB, FRCP
Angus Wilfong, MD
Section Editor
Douglas R Nordli, Jr, MD
Deputy Editor
April F Eichler, MD, MPH


Epilepsy is a condition characterized by an underlying susceptibility for recurrent seizures. The term seizure refers to a transient occurrence of signs and/or symptoms due to abnormal excessive neuronal activity of the brain.

Paroxysmal events are frequent in infancy. In one population-based cohort, they occurred in 9 percent of those in the first year of life [1]. While seizures and epilepsy are commonly considered in the differential, these make up a small fraction (<10 percent) of these events.

Neonates and infants exhibit nonepileptic paroxysmal episodes that differ from those encountered in older children and adults (table 1). These may be difficult to differentiate from epileptic events because of the overlapping clinical symptoms as well as the difficulty in interpreting neonatal and infant electroencephalograms (EEG). It is important for clinicians to be aware of and recognize the transient nonepileptic events that resemble seizures in order to avoid unnecessary treatment and to institute the correct treatment when required.

This topic reviews nonepileptic paroxysmal events in the neonate and infant. The differential diagnosis of epilepsy in other age groups is reviewed separately. (See "Nonepileptic paroxysmal disorders in children" and "Nonepileptic paroxysmal disorders in adolescents and adults".)


Normal neonates commonly exhibit a variety of paroxysmal movements including nonconjugate eye movements, sucking movements without associated eye abnormalities, and sleep-related myoclonus. These normal behaviors as well as the pathologic conditions discussed below can be difficult to distinguish from epileptic seizures, which can also have somewhat subtle manifestations. Electroencephalography (EEG), particularly video EEG monitoring, can be invaluable in distinguishing among these entities. In one study of neonates, 90 percent of abnormal movements suspicious for seizures were found to be nonepileptic on EEG recording [2]. (See "Clinical features, evaluation, and diagnosis of neonatal seizures".)

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Literature review current through: Oct 2017. | This topic last updated: Sep 09, 2016.
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