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Letters to the Editor Indian Pediatrics 2001; 38: 1197-1198 |
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Sleep Related Infantile Tremors |
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I read with interest the recent article on benign neonatal sleep myoclonus (BNSM)(1). I came across a baby who did not have myoclonus but marked tremors related with sleep. A 5½-mo-old male baby weighing 7 kg was brought with history of coarse sideways tremors of head, arms and hands, always in that order, beginning at the age of 4 mo. Each episode lasted a few seconds and occurred only when the child was about to sleep while breast-feeding. During an episode, the baby continued to take feed, did not loose consciousness, felt pain if pricked and always went to sleep after the episode but was easily arousable. The movements disappeared if the mother pressed the baby close to her chest and restrained the arms, reappearing if pressure was released. There was no color change during the episode. Physical examination of the baby was unremarkable and milestones normal. The movements gradually decreased in frequency and intensity as the baby grew up and by the age of 8 mo, he was completely free of them. The physical examination was unremarkable and he had attained all the growth and developmental milestones appro-priate for age when last examined at 8½ mo of age. Subtle seizures are the most common type of neonatal seizures(2). Subtle and other seizures are difficult to distinguish from some normal neonatal behavior, e.g., jitteriness. However, this is clearly a case of non-seizure activity because of the following factors: there were no autonomic phenomenon like colour change, drooling or apnea, there were no eye movements, movements were only of one type and could be restrained and neurologic examination was normal(3). Thus, I did not consider getting an EEG or other investigations. I scanned relevant literature including atypical repetitive movements(4) and tremors(5), but this case did not fit into any of the movement types described, hence the working title ‘Sleep Related Infantile Tremors’.
Karnail Singh,
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