Diagnostic Considerations
Benign sleep myoclonus
The clinician should be familiar with this benign condition, in which rhythmic movements (which occur only during sleep) mimic seizures. The condition can be alarming and may occur focally during nonrapid eye movement (non-REM) sleep. Video EEG monitoring shows no electrographic seizures.
Jitteriness
Jitteriness must be differentiated from seizures in neonates. Jitteriness is not associated with ocular deviation. It is stimulus sensitive (eg, triggered by stimulation or easily stopped with passive movement of the limb). The movement resembles a tremor, and no autonomic changes, such as tachycardia, are associated with it.
Seizures often are associated with ocular deviation and are not stimulus sensitive. Autonomic changes frequently accompany them. The movements are clonic, unlike the tremorlike movements of jitteriness.
Other conditions to consider in the differential diagnosis of neonatal seizures include the following:
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Anoxia
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Benign epilepsy syndromes
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Mitochondrial cytopathies
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Myoclonic epilepsy
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Myoclonus
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Organic acidurias
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Pyridoxine-dependent epilepsy
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Subarachnoid hemorrhage
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Subdural hematoma
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Tuberous sclerosis
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Vein of Galen malformation
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Viral encephalitis
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Viral meningitis
Differential Diagnoses
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Shuddering Attacks
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Onset of neonatal seizure demonstrating a focal onset in the right frontal (FP4) region. At this point, the child had head and eye deviation to the left.
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Twenty seconds into a seizure that had focal onset in the right frontal (FP4) region, the seizure shows a rhythmic buildup of activity in the right frontocentral region.
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This seizure had focal onset in the right frontal (FP4) region and subsequent buildup of activity in the right frontocentral region. As the seizure evolves, the electroencephalogram shows diffuse involvement of both cerebral hemispheres.
