Paroxysmal events that mimic epilepsy, and their precipitants, prodromes, and distinguishing features are reviewed by researchers at Texas Tech University, Lubbock, TX, and American University of Beirut, New York. They include syncope, long QT disorders, breath-holding episodes, compulsive self-induced valsalva syncopal convulsions, apneic episodes, hyperekplexia, familial hemiplegic migraine, basilar migraine syncope, benign paroxysmal vertigo, alternating hemiplegia, Alice in Wonderland syndrome, psychogenic seizures, motor tics, paroxysmal torticollis, paroxysmal dyskinesias, dystonic choreoathetosis, kinesigenic choreathetosis, paroxysmal dystonia induced by exercise, episodic ataxia, benign myoclonus of early infancy, shuddering attacks or tremors, neonatal jitteriness, Sandifer syndrome (gastroesophageal reflux), stereotypies (repetitive movements), paroxysmal tonic upward gaze, oculomotor apraxia, spasmus nutans, opsoclonus, daydreaming, sleep disorders, nonrapid eye movement arousal disorders, rapid eye movement nightmares or sleep paralysis, sleep transition head banging and body rocking, benign neonatal sleep myoclonus, and narcolepsy-cataplexy syndrome. These potential mimickers of epilepsy may be classified according to age of occurrence and clinical presentation. [1]

COMMENT. As presented in this extensive review, paroxysmal nonepileptic events in infants and children comprise an expanding spectrum. The misdiagnosis of epilepsy in children with apparent refractory seizures, reported to be as high as 39% [2], leads to unnecessary investigation and potentially toxic antiepileptic therapy. Diagnosis of a nonepileptic event requires a careful history and a normal ictal EEG.