Nature of Recovery

Immediate recovery after an apparent generalized tonic-clonic seizure favors a functional etiology. But this rule does not hold for all conditions producing loss of consciousness. Rapid recovery is common after syncope or positional vertigo. Postictal dysfunction following epileptic seizures can be divided broadly into early, intermediate, and prolonged effects. Early postictal disturbance is common in the first hour, particularly after complex partial seizures, and may include somnolence,...

Ameliorating Factors

Ameliorating factors consist of circumstances or activities employed by the patient to abort spells after they have begun. The clearest use of amelioration is paper-bag rebreathing to terminate a hyperventilation attack. Napping may terminate bouts of daytime hypersomno-lence episodes or migraines, and food may shorten the duration of hypoglycemic episodes. The head-down position reverses symptoms of hypovolemic or vasova-gal syncope. Lying still, perhaps in a specific posture good ear down for...

Benign Paroxysmal Vertigo

Benign paroxysmal vertigo is reflected by the recurrence of events of brief dysequilibrium in young children. When the attacks occur, the child appears frightened and off balance, often reaching out to steady himself. The events may be associated with nystagmus, diaphoresis, nausea, and vomiting. These attacks occur in toddlers and young children but typically resolve by age 5 years. Neurologic examination, development, and EEG are normal. A later association with migraine has been reported 21...

Sensory Seizures

Sensory seizures 2.2 Non-Motor - 2.0 are difficult to define in children because of lack of overt ictal behavior and a child's often limited ability to communicate the experience. Patients may complain of tingling, numbness, pain, heat, cold, or electric shock sensations. The case illustrates a simple partial seizure initially thought to be a migraine variant and subsequently attention-seeking behavior. Case Study 5. A 6-year-old boy complained of pulsations in his head up to several times a...

Jitteriness

Jitteriness is a common movement phenomenon in the newborn period. Jitteriness is associated with drug withdrawal, hypocalcemia, hypoglycemia, and hypoxic-ischemic encephalopathy. Movements typically have an oscillating quality, with to and fro oscillations of equal frequency and amplitude. Jitteriness can occur spontaneously, but is also very stimulus-sensitive and can often be precipitated by touch or loud noise. In addition, the movements can be dampened by consoling the child, removing the...

Benign Paroxysmal Vertigo of Childhood

This is the most common of the migraine equivalents 116 . Although affected preschool children are often referred to as having epilepsy, the characteristic history of anxious arrest of movement without loss of awareness and subjective vertigo or drunking makes the diagnosis easy. A related migraine equivalent, benign paroxysmal torticollis of infancy, has been discussed under Paroxysmal Disorders of Movement. Case study 7. A 2-year-old girl had a 6-month history of episodes in which she had...

Induction Of Episodes

It is useful to attempt the induction of an episode. This process begins by asking the patient or observers what conditions were present at the onset of the attack. These conditions should then be replicated if possible. If an attack occurred upon assuming the upright position or tilting the head back and to the left, the patient should be asked to do so in clinic. A diagnosis of orthostasis or vertigo, respectively, may emerge. Anxiety attacks related to phobias occasionally can be...

We

E would like to dedicate this book to our families. To Nora Frenkiel, Emma, Alexander, Lenna and Martin Kaplan, and Donna Fisher Preface ix Acknowledgments xi Contributors xiii Introduction Approach to the Diagnosis of Possible Seizure 1 Robert T. Wechsler, MD, PhD and Robert S. Fisher, MD, PhD SECTION I GENERAL CONSIDERATIONS INVESTIGATION, ANATOMY, AND EPILEPTIC NONEPILEPTIC DIAGNOSTIC DILEMMAS 1. Electroencephalography in the Diagnosis of Nonepileptic and Epileptic Conditions 15 2....