Publication

Abstract : We read with great interest the study by Thabit et al. on non-epileptic paroxysmal events in Egyptian children [1]. We applaud the authors (first study from Africa) for describing a large cohort of 171 children with non-epileptic events, constituting 19.5% of those with initial diagnosis of suspected epilepsy. Breath-holding spells were the commonest events in nearly one-third of patients (71% girls), followed by syncope and psychogenic non-epileptic seizures (PNES) [1]. However, we agree that the proportion of each non-epileptic event seen in this study may not represent the true picture in the community since the denominator in this study consisted of those with initial diagnosis of suspected epilepsy instead of all non-epileptic events. Also, many children might have not been referred. Authors nicely detail the clinical phenomenological analysis of these events based on history, home videos (if available), and video EEG recordings (done in 86/171 patients). However, routine EEG was done for all patients in the study. This undermines the importance of phenomenological analysis based on history and home videos which is the mainstay of diagnosis for most non-epileptic events except PNES in resource-limited settings. Also, routine EEG may not be needed in all non-epileptic events with characteristic phenomenology such as breath holding spells. Epileptiform abnormalities are known to occur in otherwise healthy children without epilepsy. Furthermore, it would be interesting to know the diagnostic yield of history, home videos, and video EEG for each of the non-epileptic events described in this study. The utility of home-videos for diagnosis of epilepsy and other paroxysmal events cannot be understated in this era of COVID-19, with special focus on tele-child-neurology [2,3] [5]. Authors highlight the possibility of misdiagnosis in non-epileptic events. We agree that misdiagnosis and unnecessary antiseizure medication use is not uncommon [4]. However, diagnostic lag, misdiagnosis rates, and rates of unnecessary antiseizure medication use were not captured for each of the non-epileptic events in this study. Besides, non-epileptic events often coexist with epilepsy. This aspect has also not been described well in this study.