Syncopes and other paroxysmal events

Paroxysmal Nonepileptic Events in Children: A Video Gallery and a Guide for Differential Diagnosis

Purpose

of review Paroxysmal Non-Epileptic Events (PNEEs) are a heterogeneous group of time-limited events, characterized by changes in motor or behavioral activity beginning abruptly and ending in a short time. Due to their manifestation, these conditions can clinically simulate seizures.

Recent findings:

These episodes belong to different categories including syncopal events, psychiatric disorders, movement disorders, and many others. PNEEs are a common cause of diagnostic mistakes and families’ concerns and the risk of useless and sometimes even injurious treatment is considerable. The high frequency of these manifestations in clinical practice makes PNEEs a diagnostic challenge for clinicians.

Current approaches to the clinical assessment of syncope in pediatric population

INTRODUCTION

Syncope is one of the most common clinical problem in children. This disorder is characterized by transient, spontaneously self-terminating loss of consciousness with brief duration and complete recovery. This situation is usually alarming for the families of patients. The mechanism of syncope is transient global brain hypoperfusion to levels below those tolerated by cerebrovascular autoregulation. Syncope can occur with many different etiologies in the pediatric population.

CLASSIFICATION

Syncopes are divided into three major categories as neurally mediated syncope, cardiovascular-mediated syncope, and non-cardiovascular syncope.

CLINICAL FEATURES

The major challenge in the assessment of children with syncope is that most children are asymptomatic at the time of their presentation, therefore making a careful and detailed history and a comprehensive physical examination essential in all patients. A trigger stimulus is detected in some cases, and this is an important clinical clue for the diagnosis. Cardiac causes of syncope in children are rare but can be life threatening and have the highest risk of morbidity and mortality. Misdiagnosis of epilepsy is common in patients presenting with syncope; therefore, the differential diagnosis between epileptic seizures and syncope is very important. It should be remembered that the evaluation of syncope in children is costly and diagnostic workup has a limited diagnostic yield.

CONCLUSION

The aim of this article is to present different types of syncope and to provide new practical clinical approaches to the diagnosis, investigation, and management in the pediatric population.