OBJECTIVE: The aim of this study was to propose guidelines to clinical investigation of patients with an apparent life threatening event (ALTE) with focus on the differential diagnosis with first seizure. METHODS: Based on literature review and a consensus meeting, members of the Sudden Infant Death Committee (SIDS) of the Latin American Society of Pediatrics (ALAPE) elaborated guidelines to help pediatricians evaluate children with ALTE. RESULTS: The proposal presented starts evaluating the gravity of the event and the consequent choice for admission or outpatient follow up. The search for etiology should be gradual starting with low complexity exams. After discharge follow up should be individualized as the choice of home monitoring. An ALTE may be the first manifestation of an epileptic seizure, however, the diagnosis is sometimes delayed when an ictal EEG is not available, because interictal EEGs are often normal and gastroesophageal reflux, a disorder very prevalent in early childhood, may mislead the diagnosis of the epileptic manifestation. CONCLUSIONS: ALTE cannot be considered an etiological diagnosis, moreover, it is a group of signs and symptoms that should be thoroughly investigated. Although not often, an apneic spell may be the only manifestation of partial seizures. This possibility should be reminded and ruled out in the etiological diagnosis of children with ALTE. The information provided in this guideline may help in the evaluation and follow up of ALTE patients, including a reduction on time and cost of hospitalization.
ALTE; SIDS; sleep; childhood
