Table 2

Examples of non-epileptic events encountered in children with neurodisability

ConditionExamples of associated paroxysmal non-epileptic events
Autistic spectrum disorder
  • Motor stereotypies

  • Self-stimulatory behaviours (eg, compulsive Valsalva manoeuvre leading to reflex anoxic seizures)

  • Sensory processing issues (eg, unusual visual experiences)

Cerebral palsy (all types)
  • Associated dystonia (repetitive twisting movements)

  • Status dystonicus

  • Dyskinetic movement disorders (eg, choreoathetoid movements)

  • Agitation episodes manifested by hypermotor or tonic spasm features (with or without autonomic accompaniments) due to undiagnosed or undertreated comorbidities that can cause pain such as gastro-oesophageal reflux, constipation, orthopaedic problems, dental pain … etc. Every effort should be made to assess for pain and to rule these causes out

Post brain injury
  • Subcortical myoclonus

  • Tonic spasms

  • Paroxysmal autonomic instability with dystonia: tachycardia, hyperthermia, hypertension, agitation and extensor posturing

Intellectual disability
  • Timeout phenomenon, in which, the child would appear to be staring blankly and become motionless. This is usually situational. It may be mistaken for absence seizures

  • Self-stimulatory behaviours (eg, rocking, spinning … etc)

Rett syndrome
  • Hand stereotypies

  • Syncopal attacks secondary to hyperventilation, breath holding and prolonged QT interval

  • Abnormal behaviours (eg, ‘screaming fits’)

Neiman–Pick type C
  • Drop attacks secondary to cataplexy (sudden loss of muscle tone in response to intense emotions like laughter)

Drug-related movement disorders
  • Tics and motor stereotypies: can complicate the treatment course with methylphenidate

  • Oculogyric crisis: presents with dystonic ocular movements such as upward deviation of the eyes, periorbital twitching and prolonged staring. Agents may include domperidone, metoclopramide and carbamazepine

  • Tardive dyskinesia: characterised by rhythmic movements of the tongue, face, trunk and extremities. Can complicate prolonged treatment (>3 months) with a dopamine antagonist such as risperidone

  • Status dystonicus secondary to sudden withdrawal of baclofen or benzodiazepines