Epilepsy Fellow King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia
Rationale: In pediatric neurology outpatient clinics or ED consultations, many patients present with abnormal movements or behavioral indications of epileptic seizures that, on the investigation, lack the EEG correlates that would be classified and characterized epilepsy. They are diagnosed to have non-epileptic seizures (NES) and have been estimated to account for 5%-37% of patients who consult neurologists with seizures  Methods: In this vignette, we are present a child who was diagnosed as DRE, failed more than two AEDs with daily brief repetitive movements involving the head as right-sided turn, trunk flexion, eye blinks, and brief non-sustained upward gaze followed by a shoulder jerks. the patient was admitted to EMU where video EEG recording was started and continued for six days. Antiepileptic medications had been tapered down gradually,All events were clinical consistent of that occurs at home. As the patient's abnormal movements did not correlate with any EEG abnormality, non-epileptic events were suspected and the possibility of movement disorders or tics was raised as a differential diagnosis Results: Upon further questioning the mother, the patient did display some obsessive-compulsive behaviors. So, he was referred to the Psychiatry team, and their impression after several visits is Tourette syndrome. A variety of management strategies were offered and at discharge from clinic; most of patient’s Tics has been improved. Conclusions: Take a thorough medical history of the patient and family to narrow down the differential diagnosis. Combined, this information will foster an accurate diagnosis or determine which investigations or referrals are needed. the finding will support preventing the long-term use of unnecessary AEDs and would Improve patient quality of life.
Funding: Please list any funding that was received in support of this abstract.: The authors received no financial support for the research, authorship, and/or publication of this article.