Paroxysmal tonic upgaze mimicking epileptic seizures in infancy: a diagnostic challenge

Purpose: To describe the clinical features of paroxysmal tonic upgaze (PTU) and highlight its potential to mimicepileptic seizures in infants. Methods: We report the case of an 11-month-old infant with recurrent, brief episodes of sustained upward deviation of the eyes, first observed at six months of age. Neurological examination, psychomotor development, transfontanellar ultrasound, and video EEG were assessed. Results: The episodes progressively increased in frequency without impairment of consciousness, motor tone, or autonomic involvement. Neurological examination and psychomotor development were normal. Transfontanellar ultrasound was unremarkable, and video EEG revealed no epileptiform activity. The clinical phenotype, normal interictal findings, and absence of electrographic correlates supported the diagnosis of PTU. Conclusion: Recognition of PTU as a non-epileptic paroxysmal disorder is essential to avoid misdiagnosis of epilepsy and unnecessary therapeutic interventions.