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A diagnosis of "Near-miss Sudden Infant Death Syndrome (SIDS)" is usually made after a thorough medical evaluation fails to reveal the cause of an apneic episode. "High risk" infants are placed on apnea monitors or are treated with respiratory stimulants such as C or theophylline. We have treated over twenty infants in the past three years with C for infantile apnea. All infants had normal diagnostic evaluations, including electroencephalograms (EEG), before starting treatment. Two infants experienced short, generalized, tonic-clonic seizures soon after being treated with C (10 mg/kg). Repeat metabolic studies were normal and C levels were within the therapeutic range (8-20 mg/l). The seizures were controlled with anticonvulsants. Repeat EEG's in both patients revealed epileptiform discharges. Anticonvulsant therapy was continued with complete resolution of the apnea and no further seizures. Follow-up EEG's are now normal and both patients are off all medications. Experience in these two infants suggests: 1)There is a subgroup of patients diagnosed as "Near-miss SIDS" who have apnea associated with seizures. 2)Seizure threshold may be lowered by central nervous system stimulants such as C and may produce convulsions in infants with latent seizure disorders not detected by routine EER. 3)It is unlikely that C given in therapeutic doses directly causes seizures, since a group of premature infants treated for neonatal apnea showed only transient jitteriness at levels up to 84 mg/l. 4)C may be of value in the diagnosis of infantile apnea caused by seizures.

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Davis, J., Turmen, T. & Aranda, J. INFANTILE APNEA AND SEIZURES: A POSSIBLE ROLE FOR CAFFEINE (C) STIMULATION. Pediatr Res 18, 374 (1984).

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