Benign Conditions Mimicking Neurological Disorders in Children: A Practical Review

The diagnostic clue is the sequence: Trigger → crying/emotion → color change → loss of consciousness → stiffening/jerks → rapid recovery.Iron deficiency is associated with breath-holding spells, and assessment of iron status is appropriate when episodes are frequent or significant.An ECG is particularly useful in recurrent pallid or atypical episodes or when cardiac arrhythmia is a concern.3 Clinical Pearl"When crying precedes color change and collapse, think physiology before epilepsy." Reflex a n d VasoVagal syncopeVasovagal syncope is an important seizure mimic in older children and adolescents.Common triggers include prolonged standing, heat, dehydration, pain, fear and emotional stress.A prodrome of dizziness, visual dimming, nausea, warmth, sweating or pallor is characteristic.Importantly, syncope is not always a purely limp event.Brief tonic stiffening or irregular myoclonic jerks may accompany IntRoductIonFew events frighten parents as much as seeing their child suddenly stiffen, shake, stare, arch, fall or become apparently unresponsive.The immediate assumption is often "seizure."Yet childhood is characterized by numerous paroxysmal nonepileptic events (PNEEs) that may closely resemble epilepsy or other neurological disorders .1,2 The distinction is important.A false diagnosis of epilepsy can expose a child to unnecessary antiseizure medication, repeated investigations, restrictions on activities and schooling, and longlasting psychological consequences for the family.Conversely, an excessively reassuring approach can overlook epilepsy, cardiac syncope or another significant disorder.The fundamental clinical principle is therefore to diagnose the event before diagnosing epilepsy.A detailed account of what happened before, during and after the episode often provides greater diagnostic value than indiscriminate investigation.Home video recordings have become particularly useful adjuncts to clinical history in the assessment of childhood paroxysmal events. 1 BReath-holdIng spellsBreath-holding spells typically occur during infancy and early childhood.In the cyanotic type, frustration, anger, crying or minor injury is followed by expiratory apnea, cyanosis and occasionally transient loss of consciousness.In pallid spells, sudden pain or fright produces vagally mediated bradycardia, pallor and loss of consciousness. 3 When cerebral hypoperfusion is sufficiently prolonged, the child may become stiff, develop opisthotonus or exhibit several brief jerks.These movements can create a convincing impression of an epileptic seizure.