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Outbursts of rage or anger are common in children and they are often referred to exclude epilepsy or autistic spectrum disorder (ASD). It is important to appreciate that, as well as neurological or psychiatric disorders, a number of other conditions may present with rage, including episodic dyscontrol syndrome (EDS), 1 2 also called intermittent explosive disorder (IED). 3 4 Paediatricians may be unaware of this condition and request an electroencephalogram (EEG) to confirm or "exclude" epilepsy.
The purpose of this study is to describe a series of children with EDS or IED and outline the potential danger of misdiagnosis.
Patients
Children were identified retrospectively from all new patient referrals to paediatric epilepsy or neurology clinics over a 12-month period. All patients were seen by a single consultant in paediatric neurology (RA). A retrospective case note review was undertaken in those children with a diagnosis of EDS or IED.
Results
Of 149 new patients seen in the clinics, five (three boys and two girls, aged 7.5-10.3 years) were considered to have a diagnosis of EDS/IED. All five children were referred with a possible diagnosis of epilepsy, one from his General Practitioner and three with "temporal lobe epilepsy". All were born following normal pregnancies, with normal birth weights and uneventful perinatal periods. There was no family history of epilepsy. The mother of one of the female patients had moderate learning difficulties and adult-onset depression, but there was no other relevant family history. One boy was described as an irritable baby who slept poorly during the first 2 years of life. Early development was normal in two patients; one was thought to be a bit "slow" and two required speech and language therapy input. One boy experienced two brief febrile seizures at 15 and 17 months of age; none had experienced any epileptic seizures. None were described as having frequent temper tantrums in infancy or in nursery school. The boys presented between 6 and 7, and the girls between 7 and 8 years of age, with sudden outbursts of rage which were occasionally provoked but most were thought by witnesses to be unprovoked. The episodes lasted from 10 min to over an hour. A typical attack was described as follows: for either a trivial or no obvious reason,...