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Nonepileptic paroxysmal events account for 30% of admissions to pediatric epilepsy monitoring units,1 present with a broad semiologic spectrum,2 and are frequently manifestations of other, treatable conditions.3 We report a patient with stool withholding owing to constipation and painful defecation that was misdiagnosed as epilepsy prior to admission, leading to unnecessary exposure to antiepileptic drugs (AED) and expensive investigations.
Case report.
A 5-year-old right-handed boy was admitted to our pediatric epilepsy monitoring unit for evaluation of spells that started 7 months previously. Episodes were characterized by brief bilateral leg stiffening, staring, moaning, a blank facial expression, and decreased responsiveness. Afterwards he complained about “tummy ache.” These occurred up to 15 times per day and were refractory to AED. His teachers noted inattentiveness, staring spells, and a declining school performance. Upon further questioning, the parents reported that sometimes during the episodes the boy had leakage of stool into his pants.
Previous evaluations included normal CT and MRI scans of the head. An EEG showed epileptiform discharges, which led to a diagnosis of epilepsy and treatment with AED.
Medical …
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