Partial Seizures Presenting as Life-Threatening Apnea


Address correspondence and reprint requests to Dr. B. Singh at Department of Pediatric Neurology, Riyadh Armed Forces Hospital, P.O. Box 7897, Riyadh, Saudi Arabia.


Apneic episodes, quite common in newborns, are considered rare after age 1 month, when gastroesophageal reflux, cardiac arrhythmias, idiopathic central apnea, and seizures become included in differential diagnosis. Determining the cause of apnea is important as treatment differs significantly and can be harmful; Caffeine given for presumed idiopathic central apnea is reported to have precipitated seizures in 2 patients with apneic seizures. Two cases of partial seizures presenting as apnea in infants were studied. Interictal EEC was normal in 1 and showed focal spikes in the other. Video EEG monitoring (16 channel) showed focalictal discharge originating from temporal areas clearly preceding onset of apnea in both patients. Because therapeutic options are sometimes diametrically opposite and interictal EEGs are particularly unreliable for diagnosis, we recommend video-EEG monitoring if there is any doubt about the diagnosis before starting treatment in patients with apneic episodes.