Objective: The main objective of presenting this case report is to emphasise the importance of accurate clinical diagnosis of movement disorder in children which many times mistaken for epilepsy for the appropriate management.

Background: Movement disorders in children are almost always complex and bizarre Most often they are misdiagnosed as seizures as the stereotypes in a child is different from adults. Tics are neurological disorders which are characterised by suppressiblity suggestibility which increases with stress and associated with premonitory urge. Any child with tic disorder should also be evaluated for behavioural issues and scholastic performance.

Methods: CASE VIGNETTE. 8yrs old girl had recurrent episodes of facial twitching and fluttering of eyelids that last for a minute for past one year. There was no history of associated abnormal movements of limbs or loss of posture or loss of consciousness. The episodes do not occur during sleep. No history of developmental delay. She had behavioural problems in the form of hyperactivity , uttering obscene words. She was treated with multiple anticonvulsants carbamazepine, leveteracetam and clobazam in maximum doses yet refractory to the above management. Her EEG had diffuse slow waves in background. MRI brain was normal.

Results: The episodes which the child had been getting were facial tics. She was diagnosed to be a case of Tourette disorder who had the spectrum of facial tics, coprolalia and behaviour disorder. She responded very well to haloperidol.

Conclusions: The Clinical diagnosis of complex movement disorder in children is very important in avoiding inappropriate management. Video recording of the bizarre movements or stereotypes in a child would be very helpful along with elaborate history for accurate diagnosis.

References: 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders – Text Revision, DSM-IV TR. 4th revised ed. Washington DC: American Psychiatric Association; 2000. 2. Verdellen C, van de Griendt J, Hartmann A, Murphy T. European Clinical Guidelines for Tourette Syndrome and other tic disorders. Part III behavioural and psychological interventions. Eur child Adolesc Psychiatry. 2011; 20:197-207. 3.Shapiro AK, Shapiro ES, Young JG, Feinberg TE. Gilles de la Tourette syndrome 2nd Edn. Raven Press.New York.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorder-masquerading-as-seizure-disorder/