Non-epileptic Paroxysmal Events

Benign neonatal sleep myoclonus

• Clinical features of benign sleep myoclonus are repetitive, high-frequency myoclonic jerks of the limbs. Myoclonus can be generalized or involve a single limb.
• It typically appears soon after falling asleep and disappears with arousal.
• Symptoms resolve by 4-6 months of age.
• Treatment is not needed. Anti-epileptic drugs may make movements worse.

Hyperekplexia

• Presents as a sudden, exaggerated startle response followed by prolonged rigidity and apnea. Episodes are often triggered by an unexpected auditory or tactile stimuli.
• Several genes have been related to the disease but the most common is a glycine receptor alpha-1 subunit (GLRA1) gene mutation.
  • Secondary hyperekplexia can also be seen secondary to a brain injury. 
• In severe cases, clonazepam can be used for treatment.
  • Phenobarbital may be considered as a second line agent.

Jitteriness

• The most common paroxysm appreciated in the neonatal period.
• Movements are best described as involuntary, rhythmic, oscillatory tremors. 
• Can be triggered by touching the affected limb and suppressed with flexing the affected limb.
• Risk factors for jitteriness include prematurity, intracranial hemorrhage, sepsis, maternal substance abuse, and hypothermia. They can also be benign in the first few days of life.