Nonepileptic Paroxysmal Events Mimicking Epileptic Seizures in an Infant with Vitamin B12 Deficiency: A Diagnostic Pitfall

Abstract

Abstract Paroxysmal events in infancy may arise from both epileptic and nonepileptic causes. These two conditions are often confused with each other, and distinguishing between them can sometimes be challenging. A 9-month-old male infant was evaluated for seizure-like episodes. During the episodes, consciousness was preserved, interaction with the environment continued, and no forced eye deviation or postictal findings were observed. Clinically, rhythmic head movements, orofacial activities, and low-amplitude extremity movements were noted. Laboratory investigations revealed vitamin B12 deficiency and concomitant iron deficiency anemia. Following vitamin B12 and iron replacement therapy, the episodes completely resolved and significant clinical improvement was observed. This case highlights the importance of detailed history-taking, video analysis, and metabolic evaluation in the assessment of seizure-like episodes in infants. It also demonstrates that early recognition of treatable conditions plays a critical role in preventing misdiagnosis of epilepsy.