Video EEG analysis of non-ictal events in children.

Over a 3 year period 186 children aged 3 weeks to 17 years were studied by telemetry (prolonged video and EEG monitoring) at the Prince of Wales Children's Hospital: 74 had events considered at referral to possibly represent seizures but which were shown by clinical analysis and telemetry to be non-ictal. Nine such patients were developmentally delayed, one was neurologically impaired and 16 were both developmentally delayed and neurologically impaired. A specific diagnosis of the non-ictal events was reached in 24 subjects-postures of spasticity in children with neurological impairment (6), Münchausen-by-proxy (5), pseudoseizures (3), breathholding (2), masturbation (2), reflux (2), shudder (1), movement disorder (1), motor tic (1) and pertussis (1). Specific descriptive patterns were assigned to the remaining 51 events. These included staring (20) and jerks (16) or unusual behaviour (15). 49 inter-event EEGs were normal; 7 displayed abnormal background rhythms and 19 showed epileptiform activity. We discourage use of the term 'pseudoseizure' for the majority of the events described and prefer that a specific diagnosis be made or a descriptive analysis be provided. The events seen illustrate the wide spectrum of childhood behaviour and on occasions suggest the need for telemetry to determine their true nature.