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Mercante A, Pizza F, Pondrelli F, Zini A, Cirillo L, Tinuper P, Liguori R, Migliaccio L, Vandi S, Gobbi G, Plazzi G. Self-Induced Stretch Syncope: An Unusual Non-Epileptic Paroxysmal Event. A Case Report and Literature Mini-Review. Clin Med Insights Pediatr 2024; 18:11795565241249596. [PMID: 39281040 PMCID: PMC11402079 DOI: 10.1177/11795565241249596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/04/2024] [Indexed: 09/18/2024] Open
Abstract
Stretch syncope (SS) is a benign, uncommon, distinct condition described mainly in adolescent males. It is responsible for paroxysmal events started by stereotyped stretching actions with neck hyperextension, culminating in alteration of consciousness. Motor manifestations are often present and may be associated with a generalized slowing of the electroencephalographic activity, challenging the diagnosis. Despite a few cases reported in the literature, different mechanisms have been implied in the pathogenesis, involving both local and systemic hemodynamic phenomena. Here, we report on an 8-year-old girl with self-induced SS, providing new insights into the related neurophysiological profile and discussing the possible etiology. Our evidence of transient and dynamic vascular impairment supports the hypothesis of SS as a multifactorial disorder.
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Affiliation(s)
- Anna Mercante
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Pondrelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Stroke Unit, Maggiore Hospital, Bologna, Italy
| | - Luigi Cirillo
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ludovica Migliaccio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Stroke Unit, Maggiore Hospital, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Gobbi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Gündüz M, Gündüz BÖ, Tubas F, Dulkadir R, Çakır BÇ, Çamurdan AD, Ceylan N. The assessment of the knowledge and practices of healthcare providers regarding paroxysmal non-epileptic events (PNES) in children: A cross-sectional study. Epileptic Disord 2024; 26:79-89. [PMID: 37930114 DOI: 10.1002/epd2.20174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Paroxysmal non-epileptic events (PNEs) are a group of disorders that may be misdiagnosed as epilepsy. This study has aimed to assess the knowledge and practices of family physicians and pediatricians regarding the diagnosis, treatment, and follow-up of PNEs in children. METHODS The study was designed as a prospective cross-sectional study that was conducted between March 1, 2022, and June 1, 2022, by reaching pediatric specialists and assistants, family physicians, subspecialty assistants, and subspecialists using a Google questionnaire. The survey consists of 26 questions. The questionnaire used by the researchers was prepared in accordance with the literature search and it included detailed questions on the diagnosis, treatment, and differential diagnosis of PNEs. RESULTS A total of 37.3% worked as specialists. Most of the participants (41.3%) have worked in training and research hospitals, and 44.3% have been physicians for 6-10 years. The mean and standard deviation for the total score were 10.1 ± 2.6. The scores of family physicians were statistically lower than those of specialists, subspecialty assistants, and subspecialists. A total of 67.2% left the decision of whether the patient should stop taking their medication to another clinician. 45% of the doctors said that they were uncomfortable with the diagnosis. SIGNIFICANCE The study findings emphasized the significant knowledge gap among healthcare providers regarding PNEs in children, highlighting the need for targeted educational interventions to improve their understanding and diagnostic skills in this area.
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Affiliation(s)
- Mehmet Gündüz
- Department of Pediatric Metabolism, Ankara City Hospital, Ankara, Turkey
| | - Bahar Öztelcan Gündüz
- Department of General Pediatrics, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Filiz Tubas
- Department of General Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Ramazan Dulkadir
- Department of General Pediatrics, Ahi Evran University, Faculty of Medicine, Kırşehir, Turkey
| | - Bahar Çuhacı Çakır
- Department of Social Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Aysu Duyan Çamurdan
- Department of Social Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Nesrin Ceylan
- Department of Pediatric Neurology, Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
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Goenka A, Fonseca LD, Kumar G. Demographic and geographic variations in the access time of pediatric patients presenting with staring spells. Epilepsy Behav 2023; 145:109299. [PMID: 37336135 DOI: 10.1016/j.yebeh.2023.109299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To assess the demographic and geographic variations in access time - defined as years between the date of symptom onset and initial date of neurological care - in pediatric patients presenting with staring spells. MATERIALS AND METHODS We conducted a secondary analysis of a retrospective chart review study from 2011 to 2021. A total of 1,353 staring spell patients, aged 0 to 17.9 years, were analyzed for age, sex, race/ethnicity, insurance, county, average county annual per capita personal income, and access time. RESULTS Patients aged 0-2.9 years had the shortest median access time of 0.3 years, compared to 1.2 years in patients aged 3-12.9 years and 1.0 year in patients aged 13-17.9 years. Statistically significant differences were seen based on race/ethnicity and insurance with White patients having shorter access time of 0.5 years compared to Black patients with 1.0 year and self-pay patients having the shortest access time of 0.4 years compared to patients with private insurance (0.7 years). Warren County had the largest annual per capita personal income of $65,855 and access time of 0.5 years compared to Preble county with the least annual per capita personal income of $45,016 and access time of 1.1 years. CONCLUSION Demographic parameters of age, race/ethnicity, insurance, and annual county per capita personal income appeared to be associated with access time to initial neurological care in patients with staring spells. These associations need to be investigated further to ensure timely access to neurological care and to ensure equity in health care.
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Affiliation(s)
- Ajay Goenka
- Department of Neurology, Dayton Children's Hospital, Dayton, OH, USA; Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
| | - Laura D Fonseca
- Department of Neurology, Dayton Children's Hospital, Dayton, OH, USA.
| | - Gogi Kumar
- Department of Neurology, Dayton Children's Hospital, Dayton, OH, USA; Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
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Ozturk S, Peduk Y, Gumus H, Per H. Shuddering attacks in children: A retrospective analysis of 19 cases from a single-center in Turkey. Epilepsy Behav 2021; 117:107827. [PMID: 33621812 DOI: 10.1016/j.yebeh.2021.107827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Shuddering attacks (SA) are one of the most common childhood paroxysmal nonepileptic events (PNEs). These attacks usually start between the first 4th and 6th months of life with rapid tremors of the head and adduction of the arms and knees. A number of factors including eating, breastfeeding, and playing stimulating games have been shown to trigger the attacks; however, the exact pathogenesis remains unknown. It has been stated that there is no need for further research in patients diagnosed, and spontaneous regression is expected. PURPOSE This study aimed to identify the causes, accompanying clinical conditions, possible differential diagnosis of SA, and the role of video-electroencephalogram (V-EEG) recording for accurate diagnosis. METHODS Nineteen cases with SA have been collected from the database of Erciyes University Pediatric Neurology Clinic, where 52.6% are boys (n = 10) and 47.6% are girls (n = 9). The relationship between the onset and disappearance of SA symptoms and variables including family history, birth history, age, sleep, teething during SA, video-EEG recordings, brain imaging, and accompanying conditions such as epilepsy have been investigated by retrospective analysis. RESULTS Four cases were found to have gastroesophageal reflux, one had epilepsy, and one had Marcus Gunn Jaw Winking Syndrome. No accompanying conditions could be identified for rest of the cases. It was observed that onset of symptoms in 15 (78.9%) of 19 cases coincided remarkably with the period of teething. CONCLUSION We speculate that there might be an indirect link between SA and teething and teething may be a triggering or an aggravating factor for SA.
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Affiliation(s)
- Selcan Ozturk
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Yakup Peduk
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Hakan Gumus
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Huseyin Per
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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Mahgoob MH, Moussa MM. Neuroglobin and Prolactin As Potential Biomarkers for Differentiating Epileptic versus Nonepileptic Paroxysmal Disorders in Children. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1713153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractAt least 20% of patients referred to pediatric epilepsy centers with the suspicion of epileptic seizures actually have other conditions. Neuroglobin is a new globin member which is highly expressed in the central and peripheral nervous systems. In this article, we aimed to evaluate usefulness of neuroglobin to differentiate between epilepsy and other conditions that mimic epilepsy. Our study was conducted on 90 children divided into three groups: 30 patients with epileptic seizures, 35 children with nonepileptic paroxysmal disorder, and 25 apparently healthy, age and sex-matched children as a normal control. Complete blood count, blood chemistries including random blood glucose, calcium, sodium, in addition to serum prolactin, and neuroglobin were performed for all children. This study showed a significant increase of both serum neuroglobin and prolactin levels in epileptic group compared with nonepileptic paroxysmal disorder and control groups (p < 0.01). Serum neuroglobin showed 95% sensitivity and 95.7% specificity in the diagnosis of generalized seizures. Serum neuroglobin may be a promising novel marker to differentiate epileptic versus nonepileptic disorders in children in the emergency setting, when history and clinical presentation are equivocal.
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Association of Child Neurology-Indian Epilepsy Society Consensus Document on Parental Counseling of Children with Epilepsy. Indian J Pediatr 2019; 86:608-616. [PMID: 31177510 DOI: 10.1007/s12098-019-02946-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
When a child is diagnosed with epilepsy, counseling regarding the same is done by the treating doctor. Most parents are frightened and have poor knowledge about epilepsy. Therapeutic advice including drug dosage, administration and side effects takes up the major part of physician's time, thereby neglecting important issues like home seizure management, follow up and others. These lacunae in knowledge require systematic patient and family education. To address these issues, an expert group meeting of pediatric neurologists and epileptologists in India along with social workers/epilepsy educators, legal experts, parents, and teachers was held. The various aspects regarding parental counseling in children with epilepsy were discussed and a consensus document was formulated. Here authors present the group consensus statement on counseling parents and caregivers of children with epilepsy. This document is intended to help physicians and pediatricians counsel the families when a child is diagnosed with epilepsy.
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Kırık S, Özkars MY. Non-epileptic paroxysmal events in early childhood and role of EEG: A single center experience. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.416320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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