Episodes Mistaken for Seizures
By Dr. Raymond Kandt
You may have heard about a recent outbreak of symptoms that appeared to be seizures among a group of teenage girls in a high school in upstate New York.
Their doctors never found a cause for the tics, spasms and other symptoms and ultimately concluded that they spread among the group of girls in what neurologists call a “conversion disorder.” There have been similar outbreaks in the last ten years among teenage girls here in North Carolina and Virginia.
I understand why these unexplained symptoms are alarming for parents, and the public, but it turns out that there are all sorts of neurological episodes in children and teenagers frequently mistaken for seizures and, often, just as hard to explain.
Neurologists define seizures as abnormal and excessive electrical signals in the brain. But beyond that, much of what causes seizures remains a mystery. And it’s often hard to distinguish between a seizure and one of the many conditions often mistaken for one.
In either case, parents are almost always frightened by their child’s unexplained behavior. In my pediatric neurology office at Wake Forest Baptist Medical Center I listen carefully for the subtle signs that help me diagnose a true epileptic seizure from another neurological event.
Types of Seizures
Let me begin by explaining the three broad categories of epileptic seizures.
The most serious, once known as “grand mal seizures” and now called generalized tonic-clonic seizures, usually begin with stiffening limbs. The child may lose control of the bladder and bowels and then lose consciousness. Generally, the seizure lasts two or three minutes. The child regains consciousness and often falls asleep. In rare cases, a seizure lasts longer than half an hour and may be life threatening.
Partial seizures, the second category, are less obvious. Depending on what part of the brain is affected by the abnormal electrical signals, symptoms may include impaired responsiveness, abnormal movements, a sensation of spinning, confusion and loss of consciousness.
Absence seizures, the third category, often go unnoticed. A child may stop talking in mid-sentence and stare off into space. Moments later, the child picks up what she was saying where she left off. When the seizure passes, the child will resume talking, as if nothing happened. A child may have dozens of absence seizures a day. Eventually a parent, or in many cases a teacher, notices, and the child is referred to a neurologist like me.
The episodes mistaken for seizures also may include fainting, staring, uncontrollable movements and other unusual behaviors. Most of these conditions are harmless.
Fainting Disorders can be terrifying for parents. The fainting often comes on when a child is upset and crying. The child appears to hold his breath and then passes out.
Often the child turns blue or very pale and sweats heavily. His limbs may stiffen, as though he is having a convulsion. After a few moments, the child regains consciousness, but may soon fall asleep from exhaustion.
An epileptic seizure typically starts with stiffening limbs; a fainting spell starts with limpness. Other differences are even subtler. After a seizure, children are usually confused and almost appear to look “though” their parents rather than at them.
Children generally are not so confused after a fainting spell. Instead, their parents report that they “could see the light” in their child’s eyes.
Movement disorders such as Tourette’s syndrome or other uncontrolled tics are sometimes mistaken for partial seizures. People with Tourette’s syndrome may grunt, clear their throats or even curse involuntarily.
Tics may include repetitive and brief movements such as eye blinks, head jerks and grimaces that often come on suddenly, worsen over time, and then resolve themselves.
Children with movement disorders do not lose consciousness and they usually are well aware that they are moving or speaking in ways that they cannot control. Newborn babies often jerk their bodies in what’s known as a “startle reflex.”
Children, and adults, may experience involuntary muscular contractions as they fall asleep. These are all movement disorders, not seizures.
Confusional migraines, a rare form of migraine headache, may be mistaken for a partial seizure. The headache may cause confusion and leave the teenager with impaired speech. Another, even rarer migraine, called an Alice-in-Wonderland migraine, makes objects appear larger or smaller than they are and actions slow down or speed up.
Night terrors are common in children under five. The child wakes up screaming, with a fast heart rate and wild eyes. His mother may reach into the crib to comfort him. “I want mommy,” the child screams, because he doesn’t recognize his own mother. Usually these resolve themselves on their own.
Staring and daydreaming are sometimes confused for an absence seizure. A child may appear to be staring off into space and at first doesn’t respond to his name. Probably that child is simply concentrating or thinking about another place or time. An absence seizure is different. Generally a vacant look comes on as a child is talking, eating or playing and when it passes the child resumes whatever he was doing.
All these disorders describe behavior that can be alarming and strange. And most require a diagnosis by a neurologist trained to listen and understand the subtle differences between an epileptic seizure and one of these other neurological episodes.
Dr. Raymond Kandt is a professor of neurology at Wake Forest Baptist Medical Center. Request an appointment online or by calling 888-716-WAKE. You may also contact the medical center’s Epilepsy Information Line at 800-642-0500 with questions about epileptic seizures.