Non-Epileptic Paroxysmal Disorders (Funny Turns)

Question 1

List the causes in neonates and infants

Answer 1

1. Benign neonatal sleep myoclonus

2. Shuddering attacks

Question 2

Define benign neonatal sleep myoclonus

Answer 2

Single or repetitive episodes of jerking of arms and legs and sparing the face, typically while falling asleep

Question 3

List the causes in older infants and toddlers

Answer 3

1. ‘Breath holding attacks’
2. Reflex anoxic seizure (RAS)
3. Masturbation and other gratification phenomena
4. Febrile myoclonus
5. Benign paroxysmal vertigo of childhood
6. Benign paroxysmal torticollis
7. Night terrors

Question 4

Define ‘breath holding attacks’

Answer 4

Child starts to cry, the crying builds up, and then the child collapses to the floor at the end of expiration and turns blue

Question 5

Define RAS

Answer 5

History of suddenly going limp which may be followed by clonic jerking. At least one episode has been triggered by a noxious stimulus.

Question 6

Define febrile myoclonus

Answer 6

Short jerks associated with high fever

Question 7

Define benign paroxysmal vertigo of childhood

Answer 7

Acute onset of fear, nausea, vertigo and unsteadiness if forced to walk; rarely vomiting and nystagmus

Question 8

Define benign paroxysmal torticollis

Answer 8

Acute episodes of head tilt

Question 9

Define night terrors

Answer 9

While in deep sleep child suddenly wakes up and is inconsolable

Question 10

List the causes in childhood

Answer 10

1. Daydreaming
2. Syncope
3. Psychologically determined paroxysmal events (PDPE)

Question 11

Define PDPE

Answer 11

Also described as conversion disorders. The episodes are a psychological phenomenon.

Question 12

What are the features suggestive of PDPE?

Answer 12

1. Events triggered by specific situations
2. Events with convulsive movements that are not explained anatomically
3. Thrashing movements that wax and wane =/- pelvic thrusting
4. Eyes open during episode
5. Slumping to the floor in a dramatic manner; falls without injury
6. Violence
7. Gain from the situation
8. Generalised movements with rapid return to normal

Question 13

How do we manage PDPE?

Answer 13

1. Explain diagnosis to parent and child
2. Acknowledgement by all involved that these are non-epileptic
3. Stabilisation phase - family developing an understanding
4. Strengthen coping abilities and remove gain from behaviour
5. Psychological support