benign shuddering attacks

Benign Shuddering Attacks: Signs and Symptoms

Benign shuddering attacks are a rare condition that affects infants and young children, characterized by rapid shivering movements of the head, shoulders, and occasionally the trunk. The following are the common signs and symptoms associated with benign shuddering attacks:

• Rapid shivering movements: The most distinctive feature of benign shuddering attacks is the sudden onset of rapid shivering movements of the head, shoulders, and sometimes the trunk.
• Brief duration: These episodes typically last from a few seconds to 15 seconds [10].
• Frequency: Shuddering attacks can occur frequently, sometimes up to 100 times a day [14].
• Triggered by normal activities: These episodes often occur during normal activities such as nursing, eating, or urination [14].
• No impairment of consciousness: Benign shuddering attacks do not impair consciousness, and the child remains aware of their surroundings.
• Normal neurologic examination findings: A normal neurologic examination and electroencephalogram (EEG) tracing confirm that this condition is benign and does not indicate any underlying neurological disorder [11].
• Facial expression changes: During an attack, facial expression can change, including staring, eye deviation, lip tightening, and teeth clenching [10].

It's essential to note that these symptoms are distinct from those of epileptic seizures, which can cause loss of consciousness, limb jerking, or other neurological signs. A proper diagnosis by a healthcare professional is necessary to rule out any underlying conditions.

References: [1], [3], [4], [6], [7], [10], [11]

Benign shuddering attacks, also known as shuddering attacks or transient infant movements (TIM), are typically diagnosed based on a combination of clinical evaluation and normal diagnostic test results.

• Normal Neurologic Examination: A thorough neurologic examination is usually performed to rule out any underlying neurological conditions. In the case of benign shuddering attacks, the examination findings are typically normal [3][7].
• Normal Electroencephalogram (EEG) Tracing: EEG tracings are often performed to evaluate for any abnormal electrical activity in the brain. For benign shuddering attacks, the EEG tracing is usually normal, with only muscle artifacts present during an attack [2][3][5][6].
• No Further Diagnostic Workup Needed: Once the diagnosis of benign shuddering attacks is confirmed, no further testing or treatment is typically needed.

It's worth noting that diagnostic tests such as MRI, blood tests, or neuropsychological assessments may be normal in patients with epilepsy, but these tests are not necessary for diagnosing benign shuddering attacks [11].

References:

[1] Piscitello LM, Volponi C, Santarone ME, Mariani R, Fusco L Epileptic Disord 2021 Oct 1;23(5):713-717. doi: 10.1684/epd.2021.1317. [2] by JJ Wang · 2021 · Cited by 2 — Normal neurologic examination findings and normal electroencephalogram tracing will confirm that this child has shuddering attacks, a benign phenomenon that ... [3] by S Ozturk · 2021 — This study aimed to identify the causes, accompanying clinical conditions, possible differential diagnosis of SA, and the role of video-electroencephalogram (V- ... [4] by JJ Wang · 2021 · Cited by 2 — Normal neurologic examination findings and normal electroencephalogram tracing will confirm that this child has shuddering attacks, a benign phenomenon that ... [5] Tracings show low-amplitude, high-frequency (8 to 10 cycles per second) motor movements, differing from the myoclonic or ... [6] Diagnostic tests, including EEG, MRI, blood test or neuropsychological assessment, will support the diagnosis of seizures but may be normal in patients with epilepsy. ... Shuddering or shivering attacks are benign non-epileptic events that typically begin in infancy. The clinical events consist of rapid shivering of the head, shoulder, and ... [7] Benign myoclonus of infancy and shuddering attacks are both benign variants of normal behavior in children. The age at onset of these attacks is typically around 4 months, but they can persist up to the age of 6–7 years, with a relapsing-remitting course. Attacks, usually self-limiting, can be very frequent and normally last a few seconds. [11] Diagnostic tests, including EEG, MRI, blood test or neuropsychological assessment, will support the diagnosis of seizures but may be normal in patients with epilepsy. ... Shuddering or shivering attacks are benign non-epileptic events that typically begin in infancy. The clinical events consist of rapid shivering of the head, shoulder, and ...

Treatment Options for Benign Shuddering Attacks

Benign shuddering attacks, also known as benign nonepileptic spasms, are a type of movement disorder that typically affects infants and young children. While they can be distressing for parents, these episodes are generally harmless and do not require medical treatment.

• No Treatment Necessary: According to various studies [7][9], shuddering attacks are considered a benign condition and do not require any specific treatment. In fact, attempting to treat them may only serve to confuse the diagnosis and lead to unnecessary interventions.
• Propranolol Therapy: However, some research suggests that propranolol, a medication commonly used to treat essential tremor [11], may be effective in reducing the frequency or severity of shuddering attacks. This treatment approach is still considered experimental and should only be pursued under the guidance of a qualified healthcare professional.
• Reassurance and Support: For parents, reassurance and support are often the most important aspects of managing benign shuddering attacks. By understanding that these episodes are harmless and will eventually resolve on their own, families can focus on providing comfort and emotional support to their child.

It's essential to note that a proper diagnosis is crucial in distinguishing shuddering attacks from other conditions that may require medical attention. If you're concerned about your child's symptoms or have questions about treatment options, consult with a qualified healthcare professional for personalized guidance.

Benign shuddering attacks, also known as shuddering spells or infantile shudders, are a type of paroxysmal nonepileptic event (PNEE) that typically begins in infancy. The differential diagnosis for benign shuddering attacks includes several conditions that can be confused with this condition.

Possible Differential Diagnoses:

• Benign Neonatal Sleep Myoclonus: This is a condition characterized by sudden, brief muscle contractions during sleep, which can be mistaken for shuddering attacks.
• Jitteriness: Jitteriness is a condition that involves rapid, involuntary movements of the limbs or trunk, which can be similar to shuddering attacks.
• Epilepsy: Epileptic seizures can sometimes be misdiagnosed as benign shuddering attacks, especially in infants and young children.
• Benign Myoclonus of Infancy: This is a condition characterized by sudden, brief muscle contractions that can be mistaken for shuddering attacks.
• Tremor: A tremor is an involuntary shaking or trembling movement that can be similar to shuddering attacks.

Key Features to Distinguish Benign Shuddering Attacks:

• Rapid Tremor of the Head and Shoulders: Benign shuddering attacks are characterized by a rapid tremor of the head and shoulders, which can continue to the trunk.
• Brief Duration: These events typically last only 1-2 seconds.
• Frequent Recurrence: Shuddering attacks can occur frequently, sometimes up to 100 times a day.

Diagnostic Tools:

• Videotaping: Videotaping of episodes can be helpful in distinguishing shuddering attack movements from tonic or myoclonic seizures.
• Normal EEG Findings: Documentation of normal EEG findings, with only muscle artifacts present during an attack, is essential for accurate diagnosis.

References:

[4] The differential diagnosis of shuddering attacks includes benign neonatal sleep myoclonus, jitteriness, epilepsy, benign myoclonus of infancy, and tremor. [5] Videotaping of episodes is helpful to distinguish shuddering attack movements from tonic or myoclonic seizures. However, accurate diagnosis is best supported by documentation of normal EEG findings, with only muscle artifacts present during an attack.