Affiliations: Department of Pediatrics, Faculty of Medicine, The
University of Jordan, Amman, Jordan
Note: [] Correspondence: Dr. Amira Masri, M.D., Department of Pediatrics,
Division of Child Neurology, Faculty of Medicine, The University of Jordan,
P.O. Box 1612, code 11941, Amman, Jordan. Tel.: +962 777770919; Fax: +962
65332477; E-mail: masriamira69@hotmail.com
Abstract: Paroxysmal non-epileptic disorders (PNEDs) are often misdiagnosed as
epilepsy. This study describes cases of misdiagnosed PNEDs. In addition, it
identifies aspects of the clinical assessment that may assist in reaching a
correct diagnosis. A total of 100 patients (58 boys and 42 girls) were
included. Misdiagnosed PNEDs included: breath-holding spells (37%); excessive
jitteriness and/or atypical hyperekplexia (15%); vasovagal attack (12%);
psychogenic seizures (11%); gastroesophageal reflux (10%); hyperekplexia (5%);
masturbation (3%); head nodding (2%); tic (2%); paroxysmal torticollis (1%);
migraine (1%); vitamin B12 deficiency-induced tremor (1%). Forty-four (44%)
patients were misdiagnosed with epilepsy and parents presented for a second
opinion, while 56 (56%) patients were referred with a suspicion of epilepsy.
Forty-two (42%) patients received antiepileptic treatment before presenting to
us. History emerged as the most helpful diagnostic tool. Examination was only
useful in hyperekplexia, while mobile phone video camera emerged as a
potentially useful but underutilized diagnostic tool and were present in 85% of
the patients. PNEDs are often misdiagnosed as epilepsy. Elements that were
helpful in making a correct diagnosis included history, examination, and
witnessing the attack in clinic or on mobile phones.
