Non-Epileptic Childhood Paroxysmal Disorders

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This book is written for those who evaluate the many quirks and behaviors encountered in the lives of developing children. The number of important pathologic conditions that befall this age group is staggering. However, equally staggering is the number of episodic and often benign or developmentally programmed paroxysmal events encountered in this population. The nature of these episodic events in many circumstances leads to their erroneous identification as epileptic in nature. This book serves as a compendium of those episodically manifest entities often uniquely observed in childhood. The book is organized with some foundations in terminology and an in depth analysis of epidemiology of many of these disorders. As best possible, epidemiologic data are compiled with incidence and prevalence figures provided for comparisons. Discussion on the deductive approach to their clinical assessment is provided along with emphasis on the diagnostic clues contained within the descriptive and observational information provided during clinical evaluation. A categorization of the differential features and ages of presentation are provided as a means to help direct logical diagnostic considerations. Subsequent chapters are organized by major topic (i.e.) Syncopes, Sleep Phenomena, Somatization, Factitious Illness, Movement Disorders, and Migraine Syndromes. Each chapter provides discourse on the general principles of underlying pathophysiologic mechanisms and current knowledge about the chapter topic under discussion. Specific clinical entities encompassed within the general topic are then discussed individually with particular attention to their clinical descriptions and presentations, natural history, particular pathophysiology, genetics, pertinent laboratory, and treatments. The text is amplified by pertinent tables highlighting diagnostic criteria where this applies and reference information where needed. The text is generously referenced to encompass the most relevant information available.

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Editorial Reviews

Doody's Review Service
Reviewer: Korwyn Williams, MD, PhD (Phoenix Children's Hospital)
Description: The title says it all. This is a review of the spells of childhood, which often erroneously are thought to be seizures. The author thoughtfully and exhaustively discusses the nonepileptic events which often are given short shrift in seizure reviews.
Purpose: The goal is to help clinicians better distinguish between nonepileptic and epileptic events by reviewing commonalities and differences between the two. The author also provides much useful information on epidemiology, historical and examination findings, diagnostic testing and its utility, and treatment. These events are common in any pediatric practice and well worth knowing. The book succeeds admirably in meeting his goal.
Audience: Pediatric practitioners are the intended audience. Pediatric neurologists would appreciate the epidemiological and neuroanatomical descriptions, but general practitioners (especially trainees) would appreciate the salient historical and examination findings and treatment options, which are often displayed in easy to read tables. The author, who has been a child neurologist for several decades, is currently the academic chief of the division of pediatric neurology at the University of Connecticut School of Medicine and has published articles on a wide variety of pediatric neurological issues.
Features: Paroxysmal events from breath-holding spells and migraines to confusional arousals, tics, and conversion disorders are just some of the conditions reviewed, all in great detail. The author nicely categorizes the spells (e.g., sleep-related, movement disorders, headaches, syncope, factitious disorder), providing a framework to help readers better approach these problems. The tables are particularly helpful in distilling key points from the chapters. For instance, in the initial chapter differentiating diagnostic considerations, a table titled, "Initial diagnostic paradigm for non-epileptic disorders" demonstrates how alteration in consciousness as a key element aids in refining the differential diagnosis. Another example of a useful table is in the chapter on movement disorders, in which commonly used medications with their pediatric dosing, types of movements for which they are effective, and their mechanisms of action are collected. If there are any shortcomings, it would be the exhaustive detail that sometimes only a neuroanatomist or autonomic specialist would appreciate. But, that information can be skimmed easily and information gleaned as needed.
Assessment: This is a very useful book to read and have on your bookshelf. Much of the information can be found in pediatric neurology textbooks, but this is a particularly thorough, concise, and accessible compendium for all pediatric practitioners.
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Product Details

  • ISBN-13: 9780195335378
  • Publisher: Oxford University Press, USA
  • Publication date: 4/8/2009
  • Pages: 400
  • Product dimensions: 6.30 (w) x 9.30 (h) x 1.00 (d)

Table of Contents

1 General Principles and Epidemiology 3

Introduction 3

The Clinical Problem and Epidemiology 5

2 Differentiating the Diagnostic Considerations 23

Introduction to the Deductive Approach 23

Pattern Recognition 25

Ruling Everything Out 25

Algorithmic Approach 25

Hypothesis Generation 26

The Clinical Presentations 27

Paroxysmal Paralysis or Collapse 28

Paroxysmal Posturing, Shaking, Jerking, Twitching, and Behavioral Syndromes 30

Ocular Movements and Deviations 32

Autonomic and Sensory Phenomenon 35

3 Syncope 39

Introduction to Syncope 39

The Clinical Problem and Epidemiology 39

Overview: Pathophysiology and Mechanisms 43

Testing 47

Primary Neurally Mediated Reflex Syncopes: The Clinical Conditions and Treatments 52

Cyanotic and Pallid Breath-Holding Spells 52

Swallow Syncope 61

Tussive Syncope 61

Hair-Grooming Syncope 63

Stretch Syncope 63

Postexertional Syncope 64

Micturition/Defecation Syncope 64

Venipuncture/Acupuncture Syncope 65

Visually Induced Syncope/Laughter-Induced Syncope 66

Carotid Massage/Carotid Sinus Syndrome 66

Cerebral Cortex-Induced Arrhythmias 66

Postural Orthostasis 67

Forced Valsalva Maneuver 68

Postural Orthostatic Tachycardia Syndrome (POTS) 69

Dysautonomia 72

Primary Cardiac 73

Cerebrovascular Steals 75

CNS Malformations 76

Suffocation 78

Other Comments 78

Hyperventilation 81

Paroxysmal Extreme Pain Disorder 82

4 Sleep-Related Phenomena 99

Introduction to Sleep-Related Phenomena 99

The Clinical Problem and Epidemiology 99

Overview: Pathophysiology and Mechanisms 109

The Clinical Conditions and Treatments 115

Sleep-Disordered Breathing 118

Primary Sleep Apnea ofInfancy 118

Obstructive Sleep Apnea 121

Congenital Central Alveolar Hypoventilation Syndrome 125

Hypersomnias of Central Origin 127

The Klein-Levin Syndrome 134

Parasomnias 136

Sleep-Related Movement Disorders 146

Isolated Syndromes 153

Other Considerations 155

5 Somatoform Disorder 177

Introduction to Somatoform Disorders 177

The Clinical Problem and Epidemiology 177

Overview: Pathophysiology and Mechanisms 186

The Clinical Conditions and Treatments: Non-Epileptic Seizures 188

6 Factitious Disorders 203

Introduction to Factitious Disorders 203

The Clinical Problem and Epidemiology 203

Overview: Pathophysiology and Mechanisms 209

The Clinical Conditions and Treatments: Munchausen Syndrome by Proxy Abuse 212

7 Movement Disorders 217

Introduction to Movement Disorders 217

The Clinical Problem and Epidemiology 217

Overview: Pathophysiology and Mechanisms 235

The Clinical Conditions and Treatments 239

Neonates and Infants 239

Infants and Children 242

Benign Myoclonus of Early Infancy (Benign Non-epileptic Infantile Spasms) 244

Children and Adolescents 256

Additional Unique Childhood Movements Disorders 261

8 Headache Syndromes 295

Introduction to Headache Syndromes 295

The Clinical Problem and Epidemiology 295

Overview of Pathophysiology and Mechanisms 300

The Clinical Conditions and Treatments 306

Migraine 306

Migraine without aura 309

Migraine with aura 310

Childhood Periodic Syndromes 317

Cyclic vomiting syndrome 317

Abdominal migraine syndrome 321

Benign paroxysmal vertigo 323

Alternating Hemiplegia of Childhood 326

Benign paroxysmal torticollis of infancy 333

Other considerations 335

Trauma-induced migraine 339

Treatment approaches for migraine 340

9 Further Considerations 357

Introduction 357

Overview 357

Final Considerations 359

Episodic Behavioral Syndromes 359

Other Ocular Phenomenon 360

In Closing 361

Index 363

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