ILLUSTRATIVE CASE
Involuntary Movements Misdiagnosed as Seizure During Vitamin B12 Treatment Kursat Bora Carman, MD,* Tugba Belgemen, MD,Þ and Uluc Yis, MD* Abstract: Seizures and epilepsy are a common problem in childhood. Nonepileptic paroxysmal events are conditions that can mimic seizure and frequent in early childhood. Nonepileptic paroxysmal events can be due to physiological or exaggerated physiological responses, parasomnias, movement disorders, behavioral or psychiatric disturbances, or to hemodynamic, respiratory, or gastrointestinal dysfunction. Vitamin B12 deficiency is a treatable cause of failure to thrive and developmental regression, involuntary movements, and anemia. Involuntary movements rarely may appear a few days after the initiation of vitamin B12 treatments and might be misdiagnosed as seizure. Here, we report 2 patients who presented with involuntary movements with his video image. Key Words: seizure, vitamin B12 deficiency, involuntary movement (Pediatr Emer Care 2013;29: 1223Y1224)
eizures and epilepsy are a common problem in childhood.1 There are also many conditions that can mimic them. It is important to distinguish nonepileptic paroxysmal events from epileptic seizures. In epileptic seizures, the suddenly occurring motor, sensory, autonomic, or psychic symptoms are caused by a transient dysfunction of the brain or part of the brain, caused by a sudden discharge of a group of hypersensitive neurons. Nonepileptic paroxysmal events can be due to physiological or exaggerated physiological responses, parasomnias, movement disorders, behavioral or psychiatric disturbances, or to hemodynamic, respiratory, or gastrointestinal dysfunction. They seem to be frequent in early childhood.2 Vitamin B12 deficiency is preventable, potentially reversible disorder, but may result in serious neurological problems if not treated properly.3 Symptoms of vitamin B12 deficiency in infants include megaloblastic anemia, feeding difficulties, developmental delay, hypotonia, abnormal movements, and rarely seizures.4 Involuntary movements have rarely been reported to appear after vitamin B12 treatment.5 Here, we describe 2 patients with vitamin B12 deficiency who received a misdiagnosis of seizure and developed involuntary movements during vitamin B12 replacement therapy.
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CASES Patient 1 A 13-month-old girl was referred to our pediatric neurology unit with complaints of shaking movements on the right From the Divisions of *Pediatric Neurology and †Pediatric Hematology, Gaziantep Children’s Hospital, Gaziantep, Turkey. Disclosure: The authors declare no conflict of interest. Reprints: Kursat Bora Carman, MD, Division of Pediatric Neurology, Gaziantep Children’s Hospital, Batıkent Mah. Vehbi Dinc¸erler Cad., Sena Apt. B Blok No:26/9, 27000, S¸ehitkamil- Gaziantep, Turkey (e
Involuntary Movements Misdiagnosed as Seizure During Vitamin B12 Treatment Kursat Bora Carman, MD,* Tugba Belgemen, MD,Þ and Uluc Yis, MD* Abstract: Seizures and epilepsy are a common problem in childhood. Nonepileptic paroxysmal events are conditions that can mimic seizure and frequent in early childhood. Nonepileptic paroxysmal events can be due to physiological or exaggerated physiological responses, parasomnias, movement disorders, behavioral or psychiatric disturbances, or to hemodynamic, respiratory, or gastrointestinal dysfunction. Vitamin B12 deficiency is a treatable cause of failure to thrive and developmental regression, involuntary movements, and anemia. Involuntary movements rarely may appear a few days after the initiation of vitamin B12 treatments and might be misdiagnosed as seizure. Here, we report 2 patients who presented with involuntary movements with his video image. Key Words: seizure, vitamin B12 deficiency, involuntary movement (Pediatr Emer Care 2013;29: 1223Y1224)
eizures and epilepsy are a common problem in childhood.1 There are also many conditions that can mimic them. It is important to distinguish nonepileptic paroxysmal events from epileptic seizures. In epileptic seizures, the suddenly occurring motor, sensory, autonomic, or psychic symptoms are caused by a transient dysfunction of the brain or part of the brain, caused by a sudden discharge of a group of hypersensitive neurons. Nonepileptic paroxysmal events can be due to physiological or exaggerated physiological responses, parasomnias, movement disorders, behavioral or psychiatric disturbances, or to hemodynamic, respiratory, or gastrointestinal dysfunction. They seem to be frequent in early childhood.2 Vitamin B12 deficiency is preventable, potentially reversible disorder, but may result in serious neurological problems if not treated properly.3 Symptoms of vitamin B12 deficiency in infants include megaloblastic anemia, feeding difficulties, developmental delay, hypotonia, abnormal movements, and rarely seizures.4 Involuntary movements have rarely been reported to appear after vitamin B12 treatment.5 Here, we describe 2 patients with vitamin B12 deficiency who received a misdiagnosis of seizure and developed involuntary movements during vitamin B12 replacement therapy.
S
CASES Patient 1 A 13-month-old girl was referred to our pediatric neurology unit with complaints of shaking movements on the right From the Divisions of *Pediatric Neurology and †Pediatric Hematology, Gaziantep Children’s Hospital, Gaziantep, Turkey. Disclosure: The authors declare no conflict of interest. Reprints: Kursat Bora Carman, MD, Division of Pediatric Neurology, Gaziantep Children’s Hospital, Batıkent Mah. Vehbi Dinc¸erler Cad., Sena Apt. B Blok No:26/9, 27000, S¸ehitkamil- Gaziantep, Turkey (e
