eMedicine Specialties > Neurology > Pediatric Neurology

Shuddering Attacks

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

Introduction

Background

Shuddering attacks are benign paroxysmal spells of childhood that can mimic epileptic seizures. They may superficially resemble several seizure types, including tonic, absence (typical and atypical), and myoclonic seizures.

Pathophysiology

The pathophysiology is unknown, although a relationship with essential tremor has been postulated.1 The origin is unclear, but shuddering attacks are not epileptic in nature.

Frequency

International

Incidence is unknown, but shuddering attacks are relatively uncommon.

Mortality/Morbidity

These episodes are usually benign and nondisabling. They are not associated with increased morbidity or mortality and tend to remit spontaneously.

Sex

No sex predilection is reported.

Age

The condition is seen in older infants and young children.

Clinical

History

  • Parents describe the paroxysmal episodes of shuddering attacks as a sudden flexion of the neck and trunk and adduction of the arms.
  • A shiverlike movement of the trunk ("like a chill") occurs, and the body may stiffen.
  • Consciousness does not seem to be altered, but this can be difficult to confirm.
  • The episode usually lasts 5-15 seconds.
  • Unlike epileptic seizures, shuddering attacks do not occur during sleep.

Physical

General and neurologic examination findings are normal.

Causes

The cause is unknown. A relationship with essential tremor has been postulated because there may be an increased frequency of essential tremor in the families of these children.

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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