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Journal of Child Neurology
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Apparent Life-Threatening Events: Neurological Correlates and the Mandatory Work-Up

Jacob Genizi, MD

Child Neurology Unit & Epilepsy Service, Meyer Childrens Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa 31096, Israel

Giora Pillar, MD

Sleep Laboratory Meyer Children's Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel

Sarit Ravid, MD

Child Neurology Unit & Epilepsy Service, Meyer Childrens Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa 31096, Israel

Eli Shahar, MD

Child Neurology Unit & Epilepsy Service, Meyer Childrens Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa 31096, Israel, e_shahar{at}rambam.health.gov.il

The purpose of this study was to estimate the prevalence of neurological causes for apparent life-threatening events in infants and assess the neurological work-up mandatory to diagnose such diagnosis, hypothesizing that acute neurological disorders constitute the most common etiology for such an acute event. A retrospective chart review allocated 93 infants fulfilling the criteria of the National Institutes of Health presenting at 1 week to 8 months with apnea, color changes, gagging, unresponsiveness, and alterations of body tone. An underlying neurological etiology was detected in 18 (19%), whereby 15 had seizures and 3 had central apnea. Only one electroencephalography demonstrated epileptic discharges, and brain imaging was intact. Thus, it has been concluded that neurological impairment, mainly that of seizures inducing an apparent life-threatening event, are relatively uncommon. As such, recommendations are that history taking and repeat physical examination still remain the major diagnostic tools before resorting to extensive laboratory studies.

Key Words: apparent life-threatening event • seizures • apnea • electroencephalography • cerebral imaging • electrocardiography

This version was published on November 1, 2008

Journal of Child Neurology, Vol. 23, No. 11, 1305-1307 (2008)
DOI: 10.1177/0883073808318204
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