• Neonates (0-8 wks)
• Jittery (Ca⁺⁺, Glc, HIE)
• Startle reflex
• Benign Sleep Myoclonus
• Infants (2mo-2yr)
• Breath Holding
• GERD
• Shuddering Attacks
• Stereotypy (Mannerisms)
• Rhythmic Movement D/O (sleep)
• Childhood (2-12yr)
• Staring/Daydreaming
• Tics/Myoclonias
• Movement D/Os
• Migraine equivalents
• Masturbation
• Drugs (antiemetics)
• Withholding behaviors
• Parasomnias
• Adolescents (>12 yrs)
• Syncope/Cardiac
• Psychogenic seizures

• Rapid, random bilateral/asynchronus jerking, may be forceful and rhythmic
• All stages of sleep
• Not seen during wakefulness
• Seconds-minute or even hours in sleep
• EEG normal (baseline AND during events)
• Disappears by late infancy

Benign Infantile Myoclonus

(Head Drops)

Infant with sudden head nods/drops

No extremity movements

Momentary, quick recovery

CONFUSED WITH INFANTILE SPASMS

Normal development, history and exam

MGMT: REASSURANCE

• Onset 6 months-10 yrs
• Sudden tremulous contraction (shiver)
• Flexion of Head and trunk
• Adduction and flexion of elbows
• Brief; up to 100/day; clusters
• Intervening several weeks w/o spells
• NO Tx, Gradually Disappears

• Syndrome of myoclonic encephalopathy
• Infants and Young Children
• Constant Eye-Bobbing
• Polymyoclonia of body and extremities
• Etiology
• Neuroblastoma (Paraneoplastic syndrome)
• Check Urine catecholamines
• Postinfectious (acite cerebellar ataxia
• Management
• Investigate for neuroblastoma (urine catacholamines)
• Steroids for acute Tx, self-limiting, long-term outcome not always favorable

Oculogyric Crisis

(Acute Dystonic Reaction)

• Eyes, Upper body or Whole body
• Mechanism: Dopamine Blockade
• Antipsychotics
• Metoclopramide
• Overdose of some antiepileptic drugs
• Rx: IV Diphenhydramine, IV Diazepam