Pediatric emergency medicine trisk 2608 2608
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Chapter 76 Syncope ). A syncopal episode can usually be distinguished from a
seizure on the basis of the description. The child is typically upright before the
event and often senses a feeling of light-headedness or nausea. The child then
becomes pale and slumps to the ground. Syncope can sometimes be accompanied
by brief seizure-like movements. The loss of consciousness is short-lived, and
recovery is rapid. This is in contrast to seizures, which usually have a postictal
period with sleepiness. On awakening, the child is noted to have signs of
increased vagal tone, such as pallor, clammy skin, dilated pupils, and relative
bradycardia. Patients with narcolepsy also experience sudden alterations in
alertness, with sleep occurring suddenly and uncontrollably during the daytime.
In about half of the patients, narcolepsy is associated with cataplexy, an abrupt
loss of muscle tone brought on by a sudden emotional outburst. Narcolepsy is far
less common than syncope; both occur more often in adolescents than in younger
children.
TABLE 97.1
NONEPILEPTIC EVENTS THAT MAY MIMIC SEIZURES
Breath-holding spells
Syncope
Migraine
Jitteriness
Benign myoclonus
Shuddering attacks
Tics
Acute dystonia
Gastroesophageal reflux
Night terrors
Sleep paralysis
Narcolepsy
Pseudoseizures
Single episodes of staring, involuntary movements, or eye deviation have been
found to occur commonly in the first months of life, although they rarely lead to
the parent seeking medical attention. In some children, however, these episodes
occur frequently. Children with benign shuddering attacks have episodes of
staring and rapid tremors involving primarily the arms and head, sometimes
