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Epilepsy Behav 2021 04 20;117:107827. Epub 2021 Feb 20.

Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey. Electronic address:

Background: Shuddering attacks (SA) are one of the most common childhood paroxysmal nonepileptic events (PNEs). These attacks usually start between the first 4th and 6th months of life with rapid tremors of the head and adduction of the arms and knees. A number of factors including eating, breastfeeding, and playing stimulating games have been shown to trigger the attacks; however, the exact pathogenesis remains unknown. Read More

Can Fam Physician 2021 02;67(2):107-108

Question: A 2-year-old child was recently brought into my office for repeated episodes of neck stiffening and shivering movements of the shoulders and arms. The episodes last 4 to 5 seconds and occur more than 10 times per day, with no apparent pattern except increased frequency at mealtime. Although there has never been loss of consciousness, the parent was worried that these were seizures. Read More

Seizure 2021 Mar 10;86:123-128. Epub 2021 Feb 10.

Department of Paediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.

Purpose: The misdiagnosis of non-epileptic seizures (NES) as epilepsy is one of the most common pitfalls in neuropsychiatric practice. This study aimed to describe the percentage and types of NES among children who were referred for a diagnosis of epilepsy in Upper Egypt.

Methods: We recruited a total of 876 patients who were referred to Sohag University Hospital, a tertiary referral centre in Upper Egypt, for the evaluation of suspected epilepsy. Read More

Anaesthesiol Intensive Ther 2020 ;52(3):187-196

Department of Anaesthesia, Faculty of Medicine, Menoufia University, Egypt.

Background: Shivering is a common complication of neuraxial anaesthesia. We compared the efficacy of tramadol, clonidine and pregabalin in preventing post-spinal anaes-thesia shivering in hysteroscopic procedures.

Methods: A prospective, randomized, triple-blind, controlled clinical trial involving 120 ASA I-II women, aged 18-60 years. Read More

Eur J Paediatr Neurol 2018 Mar 12;22(2):230-237. Epub 2018 Jan 12.

Neuropediatric Department, Hospital Sant Joan de Déu, Barcelona, Spain. Electronic address:

This review summarizes the current empirical and clinical literature on benign paroxysmal movement disorders in infancy most relevant to practitioners. Paroxysmal benign movement disorders are a heterogeneous group of movement disorders characterized by their favourable outcome. We pay special attention to the recognition and management of these abnormal motor conditions strongly suggestive of epileptic disorders. Read More

J Epilepsy Res 2017 Dec 31;7(2):109-114. Epub 2017 Dec 31.

Department of Neurology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.

Therapeutic hypothermia (TH) has rarely been utilized as an adjunct to anticonvulsants in treating patients with refractory convulsive status epilepticus (CSE). However, determining the effectiveness of TH in CSE is difficult due to the unavoidable use of sedative drugs to manage hypothermia. Additionally, the effectiveness of TH has not been studied in patients with refractory non-convulsive status epilepticus (NCSE). Read More

J Neurol Neurosurg Psychiatry 2016 Nov 16;87(11):1191-1203. Epub 2016 Mar 16.

Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.

Tremor is a common neurological condition in clinical practice; yet, few syndromes are widely recognised and discussed in the literature. As a result, there is an overdiagnosis of well-known causes, such as essential tremor. Many important unusual syndromes should be considered in the differential diagnosis of patients with tremor. Read More

Ann Neurol 2016 Mar 13;79(3):428-36. Epub 2016 Feb 13.

Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.

Objective: Benign familial infantile seizures (BFIS), paroxysmal kinesigenic dyskinesia (PKD), and their combination-known as infantile convulsions and paroxysmal choreoathetosis (ICCA)-are related autosomal dominant diseases. PRRT2 (proline-rich transmembrane protein 2 gene) has been identified as the major gene in all 3 conditions, found to be mutated in 80 to 90% of familial and 30 to 35% of sporadic cases.

Methods: We searched for the genetic defect in PRRT2-negative, unrelated families with BFIS or ICCA using whole exome or targeted gene panel sequencing, and performed a detailed cliniconeurophysiological workup. Read More

Pediatr Ann 2015 Feb;44(2):e18-23

There are a wide variety of paroxysmal nonepileptic events (PNEEs) in children that can mimic seizures. The type of PNEEs that need to be considered in the differential diagnosis depends on the age of symptom onset and the clinical features. In infants and toddlers, conditions that are relatively common in clinical practice such as apnea, jitteriness, shuddering attacks, and breath-holding spells may not present much of a diagnostic conundrum, whereas unusual conditions such as hyperekplexia may cause concern. Read More

Psychiatry Clin Neurosci 2015 Jun 1;69(6):351-9. Epub 2014 Dec 1.

Epilepsy Center, Neurological Institute, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, USA.

Aim: The aim of this study was to analyze in detail the clinical phenomenology of paroxysmal non-epileptic events (PNEE) in infants and toddlers.

Methods: We studied all children aged ≤2 years who were diagnosed with PNEE based on video-electroencephalographic (VEEG) recordings. We analyzed the following four clinical domains of each clinical event: (i) motor manifestations (body/limb jerking, complex motor, and asymmetric limb posturing); (ii) oral/vocal (crying, vocalization, sighing); (iii) behavioral change (arrest of activity, staring); (iv) and autonomic (facial flushing, breath holding). Read More

J Ethnopharmacol 2014 Aug 11;155(1):580-8. Epub 2014 Jun 11.

Chemistry Department, Makerere University, P.O Box 7062, Kampala, Uganda. Electronic address:

Ethnopharmacological Relevance: The aim of the survey was to document medicinal plants used in malaria treatment by Prometra (Promocion de la medicina tradicional amazonica) Traditional Medical Practitioners (TMPs) of Uganda and for search of new antiplasmodial herbal medicines (HMs) for further phytochemical analysis.

Materials And Methods: In this study, semi structured guided open and close ended questionnaires were used. Focus group discussions were conducted and key informants were chosen within the TMPs who helped in further discussions of how the herbal remedies where collected, prepared and administered. Read More

Klin Padiatr 2013 Dec 24;225(7):394-7. Epub 2013 Oct 24.

Department of Paediatrics, University Hospital Duesseldorf, Germany.

Whereas to date the internet is a main source of information for many parents, there are no restrictions regarding data presentation. Thus, the aim of this study was to assess the quality of internet material concerning paroxysmal episodes.We rated videos on YouTube for several conditions like infantile spasms, absence seizures, Sandifer syndrome, sleep myoclonus, and shuddering attacks. Read More

Semin Fetal Neonatal Med 2013 Aug 30;18(4):192-5. Epub 2013 Apr 30.

UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.

It is important to accurately diagnose epileptic seizures in early life to optimise management and prognosis. Conversely, however, many different movements and behaviours may manifest in the neonatal period and infancy that may not have at their root cause a change in electrical activity of the brain. It is important to distinguish them from epileptic seizures to avoid over- and inappropriate treatment. Read More

J Neurol Sci 2013 Jun 8;329(1-2):66-8. Epub 2013 Apr 8.

Department of Endocrinology, Mater Misericordiae University Hospital, Dublin 7, Ireland.

Shapiro syndrome is a rare entity, comprising a triad of recurrent hypothermia, hyperhidrosis and congenital agenesis of the corpus callosum. Fewer than 50 cases have been described, almost invariably in patients presenting in childhood or early adulthood. We present a case of an 80 year old woman presenting with recurrent bouts of shivering, sweating and profound malaise, who sought medical attention because the frequency and severity of attacks worsened in her later years. Read More

Epileptic Disord 2012 Mar;14(1):69-75

Department of Pediatric Neurology, Motol Epilepsy Centre, Charles University, 2nd Medical School, Motol Hospital, Prague, Czech Republic.

We report a girl with a drug-resistant frontal lobe epilepsy caused by focal cortical dysplasia, who exhibited uncommon seizures. The seizures consisted of shoulder or whole body shuddering after a short psychic aura and face grimacing. Consciousness was fully preserved. Read More

Masui 2012 Jan;61(1):96-9

Department of Anesthesiology, Kurume University School of Medicine, Kurume 830-0011.

Rett syndrome (RTT) is a congenital neurological disorder associated with mutations in the gene encoding MECP2 on the X chromosome. An 18-year-old woman (150 cm in height and 29 kg in weight) had been diagnosed with RTT and showed myotonic trismus, frequent attacks of apnea, mental retardation, spastic paraplegia, scoliosis, and microcephalus with micrognathia. She was scheduled to undergo laparoscopic fundoplication and gastrostomy under general anesthesia. Read More

J Child Neurol 2010 Jul 2;25(7):881-3. Epub 2010 Jun 2.

Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.

Shuddering attacks are benign shivering movements occurring in young children. The etiology is unknown; however, a relationship to essential tremor has been postulated. A series of 12 consecutive children were identified over a 6-year period ending January 1, 2007. Read More

Neurology 2008 Mar;70(13):e38-41

Department of General Pediatrics, Division of Paediatric Neurology, University Children's Hospital, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany.

Sante 2006 Oct-Dec;16(4):253-7

Institut de recherche pour le développement (IRD), Unité de recherche 077 Paludologie afrotropicale, Centre IRD de Hann, BP 1386, CP 18524 Dakar, Sénégal.

This study of malaria biodiversity in Senegal used an entomological approach that combined parasite surveys and clinical investigations in the mangrove area of the Saloum delta from 1996 to 1998. The parasitologic studies took place in two of the six villages in the coastal area of Palmarin (Djifère and Diakhanor) during three distinct periods: at the end of the dry season, in the middle of the rainy season, and at the end of the rainy season. The clinical investigations at the Palmarin health station took place from July 1996 through February 1998. Read More

Pediatr Neurol 2000 Nov;23(5):421-4

Department of Pediatrics; Epilepsy Center, Nishi-Niigata Central National Hospital, Niigata, Japan.

Shuddering attacks are recognized as an uncommon benign disorder occurring during infancy or early childhood. It is necessary to distinguish these episodes from epileptic seizures. The attacks seem to involve shivering movements occurring daily for several seconds without impairment of consciousness. Read More

No To Hattatsu 2000 Sep;32(5):424-9

Department of Pediatrics, Epilepsy Center, Nishi-Niigata Central National Hospital.

Shuddering attacks (SA), an uncommon benign disorder occurring during infancy or early childhood, should be distinguished from epileptic seizures. The attacks are shivering movements occurring daily for several seconds without impairment of consciousness. SA are regarded as an early premature manifestation of essential tremor (ET), and the provoking mechanism is the same between them. Read More

Scand J Infect Dis 1996 ;28(4):419-20

Department of Infectious Diseases, Marselisborg Hospital, Aurhus, Denmark.

A 20-year-old man who had spent several weeks in Asia suffered several attacks of fever, each lasting 1 day in a cyclic pattern. Initially he was suspected to have malaria, but no parasites were found in a blood smear. When he was readmitted to the hospital with high fever and shivering. Read More

Epilepsia 1994 ;35 Suppl 2:S7-17

Children's Mercy Hospital, Kansas City Missouri 64108-9898.

Convulsive epilepsies are generally unmistakable. Absence epilepsies, which are easily recognized by the provocation of an episode during hyperventilation and by the typical features of the EEG, can be overdiagnosed, especially in the child who daydreams in class and has scattered, asymptomatic, epileptogenic EEG changes. As in adults, complex partial seizures in children can be difficult to distinguish from certain behaviors. Read More

Neurology 1992 Jan;42(1):258-9

Division of Pediatric Neurology, Children's Hospital of Philadelphia, PA.

Br J Clin Pract 1990 Nov;44(11):508-9

St Mary's Hospital, Portsmouth, Hants.

A 48-year-old woman presented with a three-week history of recurrent, generalised rash, flitting joint pains, frontal headache and shivering attacks. On admission she was pyrexial and exhibited a symmetrical generalised maculopapular rash with a few target lesions. The rash faded within the first 24 hours, but over the following week it recurred at intervals of 48 hours and was accompanied by fever and headache. Read More

Am J Dis Child 1986 Jan;140(1):72-3

Three children who had frequent shuddering or shivering attacks were studied using electroencephalographic frequency modulation radiotelemetry and videotape monitoring. The attacks consisted of bilateral fine tremors, sometimes associated with stiffening of the upper extremities. The attacks were not associated with any electroencephalographic abnormalities. Read More

Neurology 1976 Nov;26(11):1027-30

Six infants and children presenting with shuddering attacks had evidence and a family history of essential tremor. Although this association had not been recognized, the shuddering spells caused considerable concern and led to a wide range of diagnoses. The attacks start in infancy or early childhood, are brief, often associated with some posturing, and may be very frequent. Read More

N Engl J Med 1976 Jul;295(3):174

Z Gesamte Inn Med 1976 Mar;31(5):153-5

A report is given on a patient in whom during treatment and prophylactic measures of paroxysmal tachycardias after intravenous application of ajmalin large attacks of fever with chills developed. The oral application evoked subfebrile temperatures and weakness. The drug-fever which was to be ascertained by exposition and omitting experiments was falsely explained for many years. Read More