Is Every Involuntary Movement Epileptic?

Introduction: Paroxysmal nonepileptic events are episodic changes in behavior, sensation, or consciousness that are similar to epileptic seizures but not associated with abnormal ictal brain electrophysiological discharges. Here, a case treated as epileptic seizure was presented in order to draw attention to paroxysmal nonepileptic events in differential diagnosis. Case: A 4 years old girl sent to our hospital with the diagnose of status epilepticus due to change in her consciousness, contractions and abnormal movements in her body, arms and legs those started after taking 6 spoonfull syrup of Peditus (R) (Containing 120 mg paracetamol, 50 mg guaifenesin, 6.25 mg pyrilamine maleate, 5 mg phenylephrine hcl in 5 ml scale) and 5 Medikinet (R) 10 mg capsules (10 mg methylphenidate hydrochloride in 1 capsule). She was conscious and cooperate and has involuntary snake-like movements throughout her body on admission. The patient's movement disturbances thought as methylphenidate-induced choreoathetosis responded to given haloperidol treatment and any sign of poisoning were not observed in the patient's follow up. Conclusion: Chorea side effects were observed in our patient but not any poisoning symptoms, who received a toxic dose of methylphenidate for her age. This suggests that methylphenidate, a central nervous system stimulant, may have therapeutic, toxic dose limits and side effects profile those associated with individual pharmacogenetic variations. Accurate distinction of chorea from drug-related paroxysmal nonepileptic events will ensure early effective treatment of patients and to protect patients from unnecessary drug risks.