eMedicine Specialties > Neurology > Pediatric Neurology

Shuddering Attacks: Treatment & Medication

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

Treatment

Medical Care

In most cases, no treatment is necessary for shuddering attacks.

  • Occasionally, if the episodes are unusually frequent or disabling, treatment may be attempted. However, there is no consistently effective treatment.
  • Do not use antiepileptic drugs. They are ineffective.
  • Propranolol can be helpful in isolated cases. However, it is used very rarely in the treatment of this condition.

Consultations

Infants and children with shuddering attacks are typically referred to a neurologist to check for possible seizures.

Medication

Medications are rarely used for shuddering attacks. However, propranolol may have some efficacy.

Beta-adrenergic blockers

These agents compete with beta-adrenergic agonists for available beta-receptor sites.


Propranolol (Inderal)

Has membrane-stabilizing activity and decreases automaticity of contractions.

Adult

40 mg PO bid initially; increase as tolerated; not to exceed 240-320 mg/d divided bid/tid

Pediatric

Not established

Coadministration with aluminum salts, barbiturates, NSAIDs, penicillins, calcium salts, cholestyramine, and rifampin may decrease propranolol effects; calcium channel blockers, cimetidine, loop diuretics, and MAOIs may increase toxicity of propranolol; toxicity of hydralazine, haloperidol, benzodiazepines, and phenothiazines may increase with propranolol

Documented hypersensitivity; uncompensated congestive heart failure; bradycardia, cardiogenic shock; A-V conduction abnormalities

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Beta-adrenergic blockade may decrease signs of acute hypoglycemia and hyperthyroidism; abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm; withdraw drug slowly and monitor closely

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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