The natural history of non-epileptic paroxysmal events (NEPE) in the first year of life was investigated in 22 babies referred for evaluation of suspected epileptic seizures at the Children’s Medical Centre of Israel, Petah Tiqva, Israel. Of 9 diagnosed with epilepsy, 4 had infantile spasms and hypsarrhythmia, 2 had focal seizures and focal spikes, 2 had generalized seizures and diffuse spikes, and 1 had benign myoclonic epilepsy with EEG spike and wave. NEPEs in 13 consisted of the following movement patterns: 1) episodes of rapid eye blinking; 2) episodes of side to side head shaking; 3) body posturing and stretching; 4) masturbation-like activity; and 5) recurrent head flexion. Interictal EEGs were normal. NEPEs continued for periods of 2 weeks to 7 months and then resolved without antiepileptic treatment. Development was normal without relapse during follow up periods of 28 to 38 months. [1]

COMMENT. In this study, almost 60% of infants referred for suspected epilepsy were presumed to have non-epileptic paroxysmal events that resolved relatively quickly without treatment. A maturational phenomenon was postulated. Prolonged EEG monitoring may have uncovered evidence of seizure discharges in some, but relatively long follow up without relapse was supportive of the NEPE diagnosis. The differential diagnosis includes benign myoclonus of early infancy, as described by Lombroso and Fejerman.