Shuddering Attacks



Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital

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Specialty Editor(s)

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine

eMedicine Salary Employment

Kenneth J Mack, MD, PhD, Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic

Nothing to disclose.

Paul E Barkhaus, MD, Professor, Department of Neurology, Medical College of Wisconsin; Director of Neuromuscular Diseases, Milwaukee Veterans Administration Medical Center

Nothing to disclose.

Raj D Sheth, MD, Professor, Mayo College of Medicine; Chief, Division of Pediatric Neurology, Nemours Children's Clinic

Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Neurology, Department of Neurology, Oregon Health and Science University; Consulting Staff, Shriners Hospital for Children

Nothing to disclose.


Shuddering attacks are benign paroxysmal spells of childhood that can mimic epileptic seizures. They may superficially resemble several seizure types, including tonic, absence (typical and atypical), and myoclonic seizures.


The pathophysiology is unknown, although a relationship with essential tremor has been postulated.[1] The origin is unclear, but shuddering attacks are not epileptic in nature.




Incidence is unknown, but shuddering attacks are relatively uncommon.


These episodes are usually benign and nondisabling. They are not associated with increased morbidity or mortality and tend to remit spontaneously.


No sex predilection is reported.


The condition is seen in older infants and young children.



General and neurologic examination findings are normal.


The cause is unknown. A relationship with essential tremor has been postulated because there may be an increased frequency of essential tremor in the families of these children.

Laboratory Studies

No laboratory studies are helpful for the diagnosis of shuddering attacks.

Imaging Studies

Brain CT scan or MRI may be performed because epileptic seizures are in the differential diagnosis. However, the results of these studies are normal.


Medical Care

In most cases, no treatment is necessary for shuddering attacks.


Infants and children with shuddering attacks are typically referred to a neurologist to check for possible seizures.

Medication Summary

Medications are rarely used for shuddering attacks. However, propranolol may have some efficacy.

Class Summary

These agents compete with beta-adrenergic agonists for available beta-receptor sites.

Propranolol (Inderal)

Clinical Context:  Has membrane-stabilizing activity and decreases automaticity of contractions.


Shuddering attack episodes tend to remit. A relationship to essential tremor occurring later in life has not been established.


  1. Vanasse M, Bedard P, Andermann F. Shuddering attacks in children: an early clinical manifestation of essential tremor. Neurology. Nov 1976;26(11):1027-30.[View Abstract]
  2. Benbadis SR. What can EEG-video monitoring do for you and your patients?. J Fla Med Assoc. Jun-Jul 1997;84(5):320-2.[View Abstract]
  3. Gilliam F, Kuzniecky R, Faught E. Ambulatory EEG monitoring. J Clin Neurophysiol. Mar 1999;16(2):111-5.[View Abstract]
  4. Watemberg N, Tziperman B, Dabby R, et al. Adding video recording increases the diagnostic yield of routine electroencephalograms in children with frequent paroxysmal events. Epilepsia. May 2005;46(5):716-9.[View Abstract]
  5. Holmes GL, Russman BS. Shuddering attacks. Evaluation using electroencephalographic frequency modulation radiotelemetry and videotape monitoring. Am J Dis Child. Jan 1986;140(1):72-3.[View Abstract]