Stool withholding presenting as a cause of non-epileptic seizures.

Determining clinically whether or not a child with abnormal movements is having seizures is rarely easy. Several non-epileptic causes of apparent seizures are well described, especially gastro-oesophageal reflux. Stool withholding is very common in childhood, and can start very soon after birth. Although it can cause major issues for the child and family, it is rarely considered by health care professionals to be more than a nuisance. A major feature of this is pain related to defaecation. Further, in order to enhance withholding and thus prevent defaecation, a child may adopt positions and facial features that can mimic seizures. This paper presents four children (two males, two females) who presented, between the ages of 3 and 13 months, over a 2-year period to a general paediatric clinic (held in hospitals in Watford and Hemel Hempstead, Hertfordshire, UK). All received multiple investigations before accurate diagnosis. This highlights the fact that stool withholding should be added to the differential diagnosis of seizures in infancy.