Benign Neonatal Sleep Myoclonus Differential Diagnoses

Updated: Dec 17, 2019
  • Author: Marc P DiFazio, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Diagnostic Considerations

Approach considerations

If benign neonatal sleep myoclonus (BNSM) is misidentified as epilepsy, treatment could result in a medicolegal challenge, especially because the medication-related side effects of anticonvulsants have become better recognized. Therefore, careful screening for epilepsy and consultation with a pediatric neurologist is recommended if treatment is to be started or continued. Likewise, if BNSM is considered, one must ensure that no other risk factors for epilepsy are present and that an experienced provider makes this diagnosis. A missed diagnosis of epilepsy is a clear medicolegal risk; therefore, this must be screened for carefully.

Numerous conditions are similar to benign BNSM, including nocturnal myoclonus, [29] and the brief, isolated jerks (ie, hypnic jerks) that often occur in healthy individuals into adulthood upon initiation of sleep. [30] Benign neonatal essential myoclonus is typically noted in older infants and generally not during sleep, which is an important distinction.

Other conditions to consider

Other conditions to consider in the workup of BNSM include the following:

  • Electrolyte disturbance
  • Fifth-day fits
  • Hyperekplexia
  • Neonatal jitteriness
  • Pathologic myoclonus

Differential Diagnoses