Epilepsy is a seizure disorder whose main clinical manifestation is “seizures”, which are often not observed by the physician, but only by the patient’s or family’s account. This is particularly true in pediatrics. Infants and children can only be described by their parents or guardians during a seizure. Currently, many children in China are only children, and their families tend to regard them as the pearl of their hearts. They are overly concerned and cared for, and consider some normal child (or other disease) movements as “abnormal”, or even suspect them as seizures. When asked, “How did you think he was epileptic?”, he would say, “I looked up epilepsy on the Internet and it might have that expression. At this point, the physician should carefully evaluate the medical history provided by the parents. The physician should be aware of non-epileptic “seizures” and distinguish them from true epilepsy. Some of the common seizures that need to be distinguished from epilepsy in infancy and early childhood are as follows: 1. “Jitteriness” in the neonatal period refers to nervousness and fear. It is an overreaction to the stimulation of the newborn’s arousal, often appearing before swaddling, diaper changing or bathing. This is because the jaws and limbs have a lower frequency and greater amplitude of shaking. At this point, if the adult gently presses the child’s arm with the palm of the hand, the shaking can be reduced or terminated, which is clearly different from a seizure. The shaking seizure is not accompanied by abnormal eye movements, no apnea, no facial color change, and normal EEG. 2. Benign neonatal sleep myoclonus starts in the neonatal period, most appear in NREM sleep, a few are seen in the REM period. It can occur in a single limb or bilaterally at the same time, and can also involve the face, trunk, and abdomen. Myoclonus may occur singly or in a rhythmic series, and the series of myoclonic jerks may recur during sleep. The neonatal neurological examination and electroencephalogram are normal. After 2 months of life, it will disappear before 6 months of age and does not require treatment. Benign neonatal convulsions were classified as epilepsy syndrome by ILAE in 1989, and “may not be diagnosed as epilepsy” was proposed in 2001. It accounts for about 2%-7% of neonatal convulsions, with peak incidence on the fifth day of life, also known as “fifth day’s fits”. It is characterized by multifocal myoclonic seizures with spikes in the EEG during seizures and nonspecific abnormalities in the interictal period. Rhythmic spikes and slow waves can be recorded during seizures. The nervous system is normal and the convulsions mostly stop within 2 weeks after birth. No antiepileptic treatment is required. 4. breath-holding seizures The first seizures are mostly seen between 6 months and 1.5 years of age, mostly with obvious triggers, all appearing when awake. Breathing stops after one or two cries, breathing stops in the expiratory phase and cyanosis appears. Sometimes there is corneal inversion, loss of consciousness, or even two or three twitches. The EEG is normal in the interictal phase and has rhythmic slow waves during the seizure. 5. Nodding spasm is most common in children 3-8 months of age. It occurs when the head is in an upright position, with a slow nodding movement, and the head is often in a tilted position. Nystagmus is a characteristic feature of the disease, mostly bilateral, with fast frequency and small amplitude, and can be horizontal, vertical or rotational nystagmus. It lasts for 4 months to several years and resolves spontaneously without sequelae. It needs to be distinguished from congenital nystagmus. 6. Non-epileptic tonic-like seizures occur in infancy, starting at 2-11 months of age and averaging 6 months. The seizures occur during wakefulness, with teeth clenching, head trembling, head slightly tilted back or forward, both arms raised, fist clenched when flexed, whole body forceful trembling for several seconds, occasionally “grunting” sound, always clear throughout the process, sometimes triggered by language or posture. The seizure can be interrupted by external stimuli. The seizure is immediately followed by a return to the original state. The people in North China sometimes call this action “playing heylo”. In 1976, Vanasse reported shuddering attacks, which are similar to this attack, but the age of onset can be up to 3 years old, and some children stop having attacks only at 5 years old, which is different from our experience. 7. early benign myoclonus in infants This disease is also known as benign non-epileptic infantile spasms, which was first reported by Lombroso in 1977. 90% of them develop between 3 and 9 months after birth. It is characterized by head nodding, forward bending of the body and raising of the upper limbs. The seizures occur in a series of several successive episodes and are consistent with tonic spasm-like seizures, much like West syndrome. The seizures are conscious, not painful, and not accompanied by crying. Sometimes it can be triggered when feeding or rubbing the face and neck. 8. Benign paroxysmal tonic upward gaze in children starting between 7 and 20 months of age, sudden onset of paroxysmal tonic upward gaze in both eyes, seizures lasting 2-8 seconds, may appear in clusters within a few minutes, clear mind, when teased with toys in front of the head will appear to gaze at the toys. It is often accompanied by ataxia. EEG is normal at the time of seizure. The seizures disappear after 1-2 years of age. 9. Infants with transient paroxysmal dystonia start at the age of 2-8 months and present with dystonia, twisting of the limbs or trunk, sometimes even in the form of corkscrew, lasting from a few minutes to 2 hours, with frequent episodes ranging from several times a day to once a month. Some infants show paroxysmal tilt neck, called infantile transient paroxysmal tilt neck, head tilted to one side and face twisted to the opposite side, the duration varies, EEG is normal. 10. Emotional cross-legged movements, also known as “masturbation-like episodes”, are common in children 1-3 years old, and have also been reported to occur within 1 year of age. It occurs more often in girls than in boys, and the seizures occur in the awake state, with eyes staring, thighs tucked in, lower limbs and trunk doing rhythmic extension and flexion, flushing and sweating. The seizures are always clear and can be terminated when the body position is changed. The hypo-intelligent child often persists until older age. 11, excessive startle syndrome neonatal onset, when there is a sudden external stimulus appears abnormal startle response. A sudden sound or light touch on the tip of the nose causes a strong startle response in the child. It lasts for about 10-15 seconds and then gradually subsides. In infancy, it leads to delayed motor development and unstable gait, often showing nervousness and fear. The EEG is normal during the seizure, and the EMG and CT examination are normal. 12, oculoclonus-myoclonus syndrome The age of onset is mostly between 1-2 years old, mainly manifested as oculoclonus, which is an involuntary, rhythmless, large, multi-directional, persistent, disorganized eye movement, obvious when chasing after an object, and the abnormal movement is reduced when the eye has been fixed on the gaze target. The child also has myoclonus in other parts of the body, ataxia, behavioral changes, and sleep disorders. Sometimes neuroblastoma is combined. The EEG is normal and ACTH treatment is effective. It is prone to relapse and has significant neurological sequelae. Stereotypic movements are common in children with neurological injury, mental retardation, autism, Rett syndrome, etc. Their behavioral disorders are characterized by repetitive stereotypic movements, such as head patting, head banging, rhythmic head shaking, body shaking, staring, hyperventilation, hand clapping, hand rubbing, etc. Video EEG can be distinguished from seizures.