Seizure mimics

Question 1

Benign myoclonus of infancy
Onset:
Often confused with:
How to exclude epilepsy:
Prognosis:

Answer 1

Onset: first year (typically 3-8 months)
Confused with: Spasms / Myoclonic seizures
How to exclude: Exam + EEG + development
Prognosis: abate by age 2

Question 2

Shuddering attacks:
Description:
Onset:
Triggered by:
Prognosis:

Answer 2

Description: Tremor of head/arms/trunk
Onset: 4-6 months
Triggered by: Strong emotions
Prognosis: progressively decrease, resolve by age 10

Question 3

Hyperekplexia
AKA:
Onset
Description
potential trigger
Affected receptor/gene
Treatment

Answer 3

-AKA: stiff baby syndrome or startle disease
- Onset: 6mo-6 years (peak 2-3 y)
- Description, Triad of:
- generalized stiffness
- Nocturnal myoclonus
- Tonic spasms w/ auditory or tactile stimuli
- Potential trigger: tapping tip of nose or glabella
- Mutation in Glycine Receptor (GLRA1 / GLRB2)
- Treatment: Clonazepam > VPA/LEV

Question 4

PNES:
% of adult admissions for vEEG
- average time until diagnosis

Answer 4

• 25-40%
• Diagnosis often delayed by 7-10 years

Question 5

PNES:
- Features associated with lower rate of remission (3)
- Features associated with Higher rate of remission (6)

Answer 5

Poorer prognosis:
- longer duration of illness
- abnormal neuropsych testing
- psychiatric comorbidities
Better prognosis:
- Male gender
- younger age at onset
- shorter duration of illnesss
- higher educational status
- Higher socioeconomic status
- minimal motor involvement

Question 6

Define Jactatio captis nocturnal
- AKA
- Age range
- Description
- Specific location of movements

Answer 6

aka Rhythmic movement disorder
- usually in infancy and childhood
- involuntary, repetitive movements of large muscle groups immediately before and during sleep
- usually head or neck

Question 7

Percentage of patients with narcolepsy who have
- sleep paralysis
- hypnogogic / hypnopompic hallucinations
- cataplexy
- automatic behaviors
- excessive daytime sleepiness

Answer 7

• Sleep paralysis: 25%
• Hypnogogic / hypnopompic hallucinations: 30%
• Cataplexy: 70%
• automatic behaviors: 50%
• excessive daytime sleepiness: 90%

Question 8

Decades in which PNES are most likely to occur

Answer 8

third or fourth decade

Question 9

Rate of incontinence in PNES

Answer 9

10-45%