Tics and non-epileptic events in children

A tic is a sudden, brief, repeated movement (blinking, sniffing, face and neck movements, shoulder shrugging) or sound (throat clearing, snorting, repeating a word or sound). Tics come in waves: excitement, tiredness and screens make them worse, while focused activity reduces them; a child can hold them back for a short time. According to a meta-analysis, a transient tic disorder occurs in about 3% of children and Tourette syndrome (motor and vocal tics lasting more than a year) in about 0.8%, more often in boys.

When to seek care: the tics last more than 1 year, cause pain or injury, interfere with your child, school or friendships, come with ADHD, obsessive-compulsive symptoms or anxiety, or started suddenly and are severe.

Treatment: according to international guidelines, the first step is educating the parents, teachers and the child — mild tics need no treatment, and related conditions (ADHD, anxiety) are always assessed. For tics that interfere, behavioral therapy is the first choice (Comprehensive Behavioral Intervention for Tics, CBIT); medication is prescribed only for moderate to severe tics, decided together with the family. An EEG is not indicated for diagnosing tics.

A few seconds of shaking of the head, shoulders and arms in a baby or small child, like a person who is cold, often at a moment of excitement or joy, sometimes at mealtime. Awareness is kept, the child goes straight back to what they were doing, and the shaking stops when you distract them. It usually begins between 4 and 14 months and goes away completely by age 3–7; the EEG is normal. In several studies, more than half of these children were first referred with suspected “epilepsy.” If the neurological exam is normal and the episodes are typical, no further tests or medication are needed. Read the full article

Between 6 months and 5 years, usually after crying, fright or pain: the child exhales and holds their breath, turns blue (cyanotic type) or pale (pallid type), and sometimes briefly loses consciousness and goes limp. The episode lasts less than a minute and the child comes around quickly. Frightening as it looks, it is benign and does not harm the brain. Iron deficiency makes the spells more frequent: in a randomized study, iron treatment reduced the frequency of spells by 88% (6% with placebo). That is why a blood test and treatment of iron deficiency are part of the exam. For the pallid type, or for spells that recur often, heart rhythm is also checked.

In the newborn period, brief, rhythmic jerks of the arms and legs during sleep (benign neonatal sleep myoclonus) stop as soon as the baby wakes and the EEG is normal; anti-seizure medication does not improve the condition and can make it worse. Other benign events: night terrors and sleepwalking, jerks while falling asleep, fainting in teenagers, “daydreaming” in small children, and neck movements linked to gastroesophageal reflux (Sandifer).

If there is still doubt, a video-EEG can help capture the episode. Seizures and epilepsy