Update in Pediatric Neurology

  • Andrea AndradeEmail author
  • Asuri N. Prasad


Paroxysmal events leading to an alteration in the level of consciousness and neurological functioning are extremely common in the pediatric population. Very often these events raise concerns on the part of caregivers as to whether such events represent epilepsy. The pediatric practitioner is required to become familiar with features of epileptic seizures and syndromes encountered in children as well as conditions that mimic epilepsy. In this chapter we provide a description and review of the most common clinical features, frequency, etiologies, differential diagnosis, approach to investigation, and selected aspects of the management of such events. To ease the process of discussion, the material is presented in three sections; the first two sections (“Epilepsy Syndromes in the Neonate” and “Epilepsy Syndromes in the Infant, Child and Adolescent”) deal with definitions and provide a broad outline of epileptic seizures, seizure semiology, value of localization, and age-dependent epilepsy syndromes. Recognition of both benign and more serious epilepsy syndromes is very important. While an approach to the differential diagnosis and management is outlined, seeking appropriate consultation with tertiary care specialists is critical. The section on “Non-epileptic Events” discusses the clinical presentation and management of non-epileptic events that mimic seizures, including conditions as diverse as the following: syncope, breathholding spells, movement disorders, and psychogenic non epileptic events.


  1. Anderson JB, Willis M, Lancaster H, Leonard K, Thomas C. The evaluation and management of pediatric syncope. Pediatr Neurol. 2016;55:6–13.CrossRefPubMedGoogle Scholar
  2. Arzimanoglou A, French J, Blume WT, Cross JH, Ernst JP, Feucht M, et al. Lennox-Gastaut syndrome: a consensus approach on diagnosis, assessment, management, and trial methodology. Lancet Neurol. 2009;8(1):82–93.CrossRefPubMedGoogle Scholar
  3. Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde BW, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia. 2010;51(4):676–85.CrossRefPubMedGoogle Scholar
  4. Brodie MJ. Modern management of juvenile myoclonic epilepsy. Expert Rev Neurother. 2016;16(6):681–8.CrossRefPubMedGoogle Scholar
  5. Cross JH. Differential diagnosis of epileptic seizures in infancy including the neonatal period. Semin Fetal Neonatal Med. 2013;18(4):192–5.CrossRefPubMedGoogle Scholar
  6. Dooley JM. Tic disorders in childhood. Semin Pediatr Neurol. 2006;13(4):231–42.CrossRefPubMedGoogle Scholar
  7. Facini C, Spagnoli C, Pisani F. Epileptic and non-epileptic paroxysmal motor phenomena in newborns. J Matern Fetal Neonatal Med. 2016:1–8.Google Scholar
  8. Gallagher RC, Van Hove JL, Scharer G, Hyland K, Plecko B, Waters PJ, Mercimek-Mahmutoglu S, Stockler-Ipsiroglu S, Salomons GS, Rosenberg EH, Struts EA, Jakobs C. Folinic acidresponsiveseizures are identical to pyridoxine-dependent epilepsy. Ann Neurol. 2009;65(5):550–6. Scholar
  9. Ganos C. Tics and Tourette’s: update on pathophysiology and tic control. Curr Opin Neurol. 2016;29(4):513–8.CrossRefPubMedGoogle Scholar
  10. Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–77.CrossRefPubMedGoogle Scholar
  11. McTague A, Howell KB, Cross JH, Kurian MA, Scheffer IE. The genetic landscape of the epileptic encephalopathies of infancy and childhood. Lancet Neurol. 2016;15(3):304–16.CrossRefPubMedGoogle Scholar
  12. Moosa AN, Wyllie E. Focal epileptogenic lesions. Handb Clin Neurol. 2013;111:493–510.CrossRefPubMedGoogle Scholar
  13. Panayiotopoulos CP. Typical absence seizures and related epileptic syndromes: assessment of current state and directions for future research. Epilepsia. 2008;49(12):2131–9.CrossRefPubMedGoogle Scholar
  14. Panayiotopoulos CP, Michael M, Sanders S, Valeta T, Koutroumanidis M. Benign childhood focal epilepsies: assessment of established and newly recognized syndromes. Brain. 2008;131(Pt 9):2264–86.CrossRefPubMedGoogle Scholar
  15. Park JT, Shahid AM, Jammoul A. Common pediatric epilepsy syndromes. Pediatr Ann. 2015;44(2):e30–5.CrossRefPubMedGoogle Scholar
  16. Pisani F, Facini C, Pavlidis E, Spagnoli C, Boylan G. Epilepsy after neonatal seizures: literature review. Eur J Paediatr Neurol. 2015;19(1):6–14.CrossRefPubMedGoogle Scholar
  17. Prasad AN, Hoffmann GF. Early onset epilepsy and inherited metabolic disorders: diagnosis and management. Can J Neurol Sci. 2010;37(3):350–8.CrossRefPubMedGoogle Scholar
  18. Reilly C, Menlove L, Fenton V, Das KB. Psychogenic nonepileptic seizures in children: a review. Epilepsia. 2013;54(10):1715–24.CrossRefPubMedGoogle Scholar
  19. Sankhyan N. Non-epileptic paroxysmal events mimicking seizures. Indian J Pediatr. 2014;81(9):898–902.CrossRefPubMedGoogle Scholar
  20. Shahwan A, Farrell M, Delanty N. Progressive myoclonic epilepsies: a review of genetic and therapeutic aspects. Lancet Neurol. 2005;4(4):239–48.CrossRefPubMedGoogle Scholar
  21. Sharma S, Prasad AN. Genetic testing of epileptic encephalopathies of infancy: an approach. Can J Neurol Sci. 2013;40(1):10–6.CrossRefPubMedGoogle Scholar
  22. Sharma S, Prasad AN. Inborn Errors of Metabolism and Epilepsy: Current Understanding, Diagnosis, and Treatment Approaches. Int J Mol Sci. 2017;18(7). pii: E1384. Review. PubMed PMID: 28671587; PubMed Central PMCID: PMC5535877.CrossRefPubMedCentralGoogle Scholar
  23. St Louis EK, Cascino GD. Diagnosis of epilepsy and related episodic disorders. Continuum (Minneapolis, MN). 2016;22(1 Epilepsy):15–37.Google Scholar
  24. Szabo L, Siegler Z, Zubek L, Liptai Z, Korhegyi I, Bansagi B, et al. A detailed semiologic analysis of childhood psychogenic nonepileptic seizures. Epilepsia. 2012;53(3):565–70.CrossRefPubMedGoogle Scholar
  25. Yeh J. Syncope in children and adolescents. Pediatr Ann. 2015;44(12):e287–91.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatriacs, Schulich School of Medicine and DentistryNeurology Division LHSCLondonCanada

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