Non-epileptic movement disorders in childhood

Paroxysmal disorders are episodic events with normality between crisis. These can be epileptic or non-epileptic, and are usually accompanied by abnormal movements.

The study of paroxysmal disorders (and the differential diagnosis of epilepsy) is one of the widest fields of Neuropaediatrics, due to the high number of referrals and the variety of problems and consequences that it brings. The differential diagnosis of paroxysmal disorders include vagal reactions, subocclusive syndrome due to intestinal malrotation or life threatening problems such as cardiac syncope. The erroneous diagnosis of epilepsy means accepting the wrong diagnosis and treatment and failing to rule out other pathologies that could be life threatening.

The diagnosis of PNEs is generally based on a careful anamnesis or video images of the episodes. Family history and details of medication used must be queried. When the diagnosis is clear, no complementary examinations are necessary. Specific analysis can be indicated to rule out symptomatic causes or other movement disorders, such as hypocalcaemic tetany. In many cases EEG is well-advised. Brain imaging, particularly MRI is required in the study of epilepsy and to rule out others pathologies in PNEs such as paroxistic dyskinesias or the alternating hemiplegia syndrome.

Most of the PNEs have no specific treatment.