eMedicine Specialties > Neurology > Pediatric Neurology

Shuddering Attacks: Differential Diagnoses & Workup

Author: Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Contributor Information and Disclosures

Updated: Sep 11, 2008

Differential Diagnoses

Absence Seizures
Frontal Lobe Epilepsy
Benign Childhood Epilepsy
Psychogenic Nonepileptic Seizures
Complex Partial Seizures
Seizures and Epilepsy: Overview and Classification
Dizziness, Vertigo, and Imbalance
Simple Partial Seizures
Epilepsy, Juvenile Myoclonic
Syncope and Related Paroxysmal Spells
Essential Tremor
Tonic-Clonic Seizures
Febrile Seizures

Other Problems to Be Considered

Benign epilepsy syndromes
Tonic seizures

For more information on epilepsy, see Medscape's Epilepsy Resource Center.

Workup

Laboratory Studies

No laboratory studies are helpful for the diagnosis of shuddering attacks.

Imaging Studies

Brain CT scan or MRI may be performed because epileptic seizures are in the differential diagnosis. However, the results of these studies are normal.

Procedures

  • Reviewing the appearance of a typical episode as captured on video camera by the parents is helpful in suggesting the diagnosis; however, prolonged electroencephalography (EEG) video monitoring to record a typical episode definitively differentiates shuddering attacks from epileptic seizures.2
  • Recordings of the spells confirm that typical characteristics of an episode are 5-10 seconds of shiver-like movements of the trunk and limbs with no impairment of consciousness and no EEG discharge during the episode. A normal EEG result helps to rule out an epileptic origin.
  • Ambulatory EEG3 without video recording is useful for diagnosis but does not record the clinical event.
  • Routine EEG results are typically normal.

More on Shuddering Attacks

Overview: Shuddering Attacks
Differential Diagnoses & Workup: Shuddering Attacks
Treatment & Medication: Shuddering Attacks
Follow-up: Shuddering Attacks
References
Further Reading
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References

  1. Vanasse M, Bedard P, Andermann F. Shuddering attacks in children: an early clinical manifestation of essential tremor. Neurology. Nov 1976;26(11):1027-30. [Medline].

  2. Benbadis SR. What can EEG-video monitoring do for you and your patients?. J Fla Med Assoc. Jun-Jul 1997;84(5):320-2. [Medline].

  3. Gilliam F, Kuzniecky R, Faught E. Ambulatory EEG monitoring. J Clin Neurophysiol. Mar 1999;16(2):111-5. [Medline].

  4. Watemberg N, Tziperman B, Dabby R, et al. Adding video recording increases the diagnostic yield of routine electroencephalograms in children with frequent paroxysmal events. Epilepsia. May 2005;46(5):716-9. [Medline].

  5. Holmes GL, Russman BS. Shuddering attacks. Evaluation using electroencephalographic frequency modulation radiotelemetry and videotape monitoring. Am J Dis Child. Jan 1986;140(1):72-3. [Medline].

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Further Reading

Tibussek D, Karenfort M, Mayatepek E, Assmann B. Clinical reasoning: shuddering attacks in infancy. Neurology. Mar 25 2008;70(13):e38-41. [Medline].

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Keywords

shuddering attacks, benign paroxysmal spells of childhood, mimic epileptic seizure, shiver-like movement, tremor, electroencephalography, EEG, seizures

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Contributor Information and Disclosures

Author

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Raj D Sheth, MD, Division Chief, Division of Pediatric Neurology, Department of Pediatrics, Nemours Alfred I duPont Hospital for Children
Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, and Child Neurology Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Kenneth J Mack, MD, PhD, Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic
Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience
Disclosure: Nothing to disclose.

CME Editor

Paul E Barkhaus, MD, Professor, Department of Neurology, Medical College of Wisconsin; Director of Neuromuscular Diseases, Milwaukee Veterans Administration Medical Center
Paul E Barkhaus, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Neurological Association
Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Neurology, Department of Pediatrics, Division of Pediatrics, Oregon Health and Science University; Consulting Staff, Shriners Hospital
Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

 
 
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