Not every event that involves jerking, staring, or impairment of consciousness is a seizure. All kinds of behavior can look like seizures, and it may take some time and tests to sort out which, in fact, are true seizures. If the events are frequent (daily to weekly), then video-EEG monitoring can be used to determine the exact nature of the event, if a home video does not provide a clear answer.

Daydreaming

We all daydream, and children daydream more than adults. Daydreaming in children can be easily confused with absence or complex partial seizures, in which staring is a prominent and common feature. However, lip smacking, eye blinking, or stiffening of muscle groups is common during seizures but not during daydreaming. Daydreaming can be stopped by calling the child's name, producing a startling noise, touching or tickling the child, or saying "Look at the kitty" or "Look at the fire truck." In addition, the parent may turn off the television, which the child is often watching rather than listening to the parent. Absence and complex partial seizures seldom can be stopped by such means, although the child may be partially responsive. Absence seizures usually last less than 10 seconds, and complex partial seizures, 30 seconds to 3 minutes. Daydreaming tends to occur when the child is tired or bored or is involved in monotonous activity, such as riding in the back seat of a car, but seizures can occur at any time. Since seizures can occur at any time, they often interupt fun ongoing play activities, a time when daydreaming does not occur. Another important distinguishing feature is the beginning of the attack. Seizures often begin abruptly. For example, in the middle of a sentence or while playing with a toy, the child may suddenly stop and stare. In contrast, daydreaming often represents the continuation of a natural pause in activity. For example, a child may be reading and raise his or her head to reflect on a sentence and then daydream.

Children with attention disorders such as ADHD may be thought to have epilepsy, or vice versa.

"Blue" breath-holding spells

In a classic "blue" (or cyanotic) breath-holding spell, a young child cries intensely (usually after some minor upset such as a bump on the head, being scolded for running into the street, or being told not to play with a toy), holds her breath, and then loses consciousness, and becomes limp. The child often turns bluish and may sweat profusely. The typical attack lasts 30 to 60 seconds. With more prolonged spells, the eyes may roll up, the entire body may become rigid and jerk, as the lack of oxygen to the brain actually triggers a seizure.

Although the seizure looks just like an epileptic seizure, the child does not have epilepsy and is not likely to develop it. The lack of oxygen in breath-holding spells and the occasional seizure that follows do not cause brain injury.

When children cry vigorously, they may exhale and then pause before taking another breath. When the pause is unusually long, it is considered a breath-holding spell. Because of the way they affect the child, breath-holding spells may be confused with atonic, tonic, or tonic-clonic seizures. (See Types of Seizures.) Distinguishing epileptic seizures from breath-holding spells is based mainly on the typical sequence of a physical or emotional upset, followed by crying and breath-holding, which helps the doctor determine that the spell was an episode of breath-holding, not epilepsy. Breath-holding spells usually begin between 6 and 18 months of age and stop before the child is 6 years old. About 25% of the patients have a family history of breath-holding spells, often not recognized, unless the child's parents ask their parents about having had similar events in infancy or early childhood.

The outlook for a child with breath-holding spells is excellent, and in most cases no treatment is needed. Parents may try to distract the child during the intense crying, as this can prevent the breath-holding spell. Parents of children who are prone to prolonged vigorous crying tantrums should try to ignore the behavior, withholding the attention and concern that reinforces it. Parents should not pick the child up during an event, as this may exacerbate the spell. The child should be placed in a recumbent position until the event is over (This is especially helpful if the event occurs while the child is in a chair.). In some cases, a psychologist may help in modifying the child's behavior.

Pallid infantile syncope

Syncope (SIN-ko-pee) means fainting. Pallid infantile syncope may be confused with atonic, tonic, or tonic-clonic seizures. In this nonepileptic disorder, which usually begins between 12 and 18 months of age and ends before age 6 years, the child suddenly becomes pale (pallid) and then faints. Often family members have had similar spells, sometimes called "pallid breath-holding spells," in early childhood. In contrast to cyanotic or blue breath-holding spells, the episodes are not consistently preceded by intense crying. If the spells are prolonged, the entire body may become rigid and jerk as the lack of oxygen to the brain triggers a seizure. These spells may result from sensitivity of the vagus nerve, which controls the heart rate. The prognosis is excellent, and treatment is rarely needed, although for some patients doctors may prescribe small doses of atropine.

Other forms of fainting

Fainting is common in children. In many cases, other family members have a history of fainting. Emotional triggers or painful situations such as having blood drawn can cause a child to faint. Children also may faint from the depletion of fluids in the body (dehydration) caused by inadequate fluid intake or excessive fluid loss, as occurs, for example, with sweating or diarrhea. Excessive sun exposure can also cause fainting. In other cases, heart disorders cause slowing of the heartbeat or a decrease in the force of the heart's contractions, causing the child to faint. Lightheadedness, dizziness, or impaired vision often precede the loss of consciousness, but fainting normally is not followed by confusion or tiredness for more than a minute. Frequent episodes of fainting should be thoroughly investigated by a doctor, who usually will record an EKG (heart rhythm strip), and check the blood pressure and pulse (heart rate) standing, sitting, and while recumbent. A cardiologist may be consulted. Avoiding the emotional triggers, having blood drawn while recumbent, and increasing your fluid and dietary salt intake may help prevent future syncopal episodes.

Movement disorders

Many nonepileptic movement disorders easily can be confused with tonic or motor seizures. Children with these disorders assume abnormal postures (parts of their body are in an unusual position, such as the fingers curled up as if in a cramp, or the foot turned inward) or make sudden, unusual movements (such as eye blinking or jerks of a body part), and the attacks may begin suddenly, thus mimicking seizures. Most of these movement disorders occur spontaneously, but others are triggered by specific events such as eating (Sandifer's syndrome).

Tics are involuntary, repetitive, intermittent, brief movements. Although tics are purposeless, they may resemble purposeful movements. The most common tics in children are eye blinks, facial grimaces, shoulder shrugs, and head movements. Tourette's syndrome is characterized by chronic motor and vocal tics. The vocal tics range from grunts and throat-clearing sounds to involuntary cursing and other embarrassing noises. Tics are not seizures, and most are self-limiting.

Sleep jerks (benign nocturnal myoclonus) are brief, involuntary muscular contractions that occur as a person falls asleep. In some cases, they may awaken someone who is drifting off to sleep. Sleep jerks are common in healthy children and adults. These normal movements may be confused with myoclonic seizures. Jerks that only occur as a person falls asleep are rarely seizures.

Topic Editor:James W. Wheless, M.D.
Last Reviewed:10/5/06