Shuddering attacks

• Shuddering episodes are characterized by periods of rapid tremor of the head, shoulders, and arms that resemble shivering.  It is often accompanied by facial grimacing with preserved consciousness 
• Onset is in infancy or early childhood, but can occur as late as 10 years of age
• The episodes last several seconds and can occur up to 100 times a day.
• Spells are often triggered by excitement, frustration, embarrassment, or surprise
• The differential diagnosis of shuddering attacks includes benign neonatal sleep myoclonus, jitteriness, epilepsy, benign myoclonus of infancy, and tremor. 
• The preservation of consciousness, predictable triggers, ability to abort an episode when distracted by a parent, and normal EEG distinguish this entity from seizures. 
• The prognosis for development and neurologic function is uniformly good. 
• Treatment is generally not needed. 

Read classification of ” Paroxysmal Non Epileptic Events PNEE“