This article needs more reliable medical references for verification or relies too heavily on primary sources , specifically: This section relies mostly on primary sources.(August 2023) |
Gratification Disorder | |
---|---|
Other names | infantile masturbation, [1] benign idiopathic infantile dyskinesia, [1] infantile gratification [2] |
Specialty | Pediatric psychiatry, pediatric neurology, child sexuality |
Symptoms | vocalizations with quiet grunting, flushing of the face , sweating, crossing or flexing legs |
Duration | variable |
Causes | No known causes |
Diagnostic method | Based on symptoms, presence of consciousness, stopping upon distraction |
Gratification disorder is a rare and often misdiagnosed form of masturbatory behavior, or the behavior of stimulating of one's own genitals, seen predominantly in infants and toddlers. [1] Most pediatricians agree that masturbation is both normal and common behavior in children at some point in their childhood. [1] [3] The behavior is labeled a disorder when the child forms a habit, and misdiagnoses of the behavior can lead to unnecessary and invasive testing for other severe health conditions, including multiple neurological or motor disorders. [1] [4] [5]
The behavior of gratification disorder closely mimics that of a seizure, though the exact appearance varies. [4] It often involves symptoms of flushing, or when the skin of the face becomes red, sweating, grunting, and erratic movements of the body. [6] The child remains conscious during episodes of infantile masturbation and can be distracted from the behavior, which could help rule out the suspicion of a serious condition. [5] Additional symptoms can include: rhythmic or rhythmical rubbing of genitals against objects or hands; [7] a fixated or dazed gaze; [8] straightening of the legs or crossed legs; [8] and a pleasant feeling post-episode. [7]
Duration and frequency of the episodes vary from as little as 5–10 minutes, [8] to episodes reported to last 30–40 minutes. [7] Some episodes occur weekly, while other reports document episodes occurring multiple times throughout a single day. [7] In general, parents of children affected by gratification disorder noted an increase in both duration and frequency as time went on before an intervention, or remedy, such as behavioral therapy was introduced. [7]
Because this behavior can be worrisome, the possibility of sexual abuse to the child should be thoroughly examined by parents and/or health care professionals to help determine that this is not the likely reason for this behavior. [4] This masturbatory behavior tends to diminish with age, and as of 2023, there were no clinical trials that explore medical approaches or defined treatment options for gratification disorder. [3] [5]
Gratification disorder may be unrecognized by both families and clinicians, [9] possibly due to the absence of genital manipulation or physical touching of the genitals. [9] Because of the inability to correctly recognize and diagnose gratification disorder, children are put at higher risk for more invasive testing because the disorder and its characteristics are largely misunderstood. [4] Failure to correctly diagnose can lead to an increased risk of unnecessary testing or the use of potentially harmful medications, such as medications used for seizures or other neurological disorders. [3] [4]
Little research has been published regarding this early childhood condition, but it is likely misdiagnosed when the child's bodily movements are of concern. [3] The behavior can look different from case to case and does not always involve direct stimulation of the genitals, so the movements exhibited by the child can also resemble conditions such as epilepsy, a neurological condition that causes unprovoked and recurrent seizures; paroxysmal dystonia, a neurological disorder causing episodes of spastic movements that cause muscles to contract involuntarily; dyskinesia, a disorder involving the involuntary contraction of muscles; and gastrointestinal disorders, which would be health issues relating to the stomach or GI tract. [1] [4] [5]
A strategy for differentiating gratification disorder, or infantile masturbation, from other movement disorders or seizure disorders is via direct observation. [10] Usually in cases of gratification disorder, the physical and laboratory examination results are normal. [10] Consciousness is also not altered in gratification disorder, which can be another key element in the differential diagnosis. [11] Children with gratification disorder are likely responsive and should stop an episode upon distraction, which is not something that would be seen in movement or seizure disorders. [5] Several studies stress the importance of direct observation and identifying features of gratification disorder to prevent unnecessary invasive testing and diagnoses. [5]
Most instances of gratification disorder occur from the ages of 3 months to 3 years but it can sometimes resurface in older adolescence. [1]
Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. An epileptic seizure is the clinical manifestation of an abnormal, excessive, and synchronized electrical discharge in the neurons. The occurrence of two or more unprovoked seizures defines epilepsy. The occurrence of just one seizure may warrant the definition in a more clinical usage where recurrence may be able to be prejudged. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly, such as broken bones, or through causing accidents. In epilepsy, seizures tend to recur and may have no detectable underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.
A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. Because epileptic seizures typically include convulsions, the term convulsion is often used as a synonym for seizure. However, not all epileptic seizures result in convulsions, and not all convulsions are caused by epileptic seizures. Non-epileptic convulsions have no relation with epilepsy, and are caused by non-epileptic seizures.
Absence seizures are one of several kinds of generalized seizures. In the past, absence epilepsy was referred to as "pyknolepsy," a term derived from the Greek word "pyknos," signifying "extremely frequent" or "grouped". These seizures are sometimes referred to as petit mal seizures ; however, usage of this terminology is no longer recommended. Absence seizures are characterized by a brief loss and return of consciousness, generally not followed by a period of lethargy. Absence seizures are most common in children. They affect both sides of the brain.
A headache is often present in patients with epilepsy. If the headache occurs in the vicinity of a seizure, it is defined as peri-ictal headache, which can occur either before (pre-ictal) or after (post-ictal) the seizure, to which the term ictal refers. An ictal headache itself may or may not be an epileptic manifestation. In the first case it is defined as ictal epileptic headache or simply epileptic headache. It is a real painful seizure, that can remain isolated or be followed by other manifestations of the seizure. On the other hand, the ictal non-epileptic headache is a headache that occurs during a seizure but it is not due to an epileptic mechanism. When the headache does not occur in the vicinity of a seizure it is defined as inter-ictal headache. In this case it is a disorder autonomous from epilepsy, that is a comorbidity.
Landau–Kleffner syndrome (LKS)—also called infantile acquired aphasia, acquired epileptic aphasia or aphasia with convulsive disorder—is a rare childhood neurological syndrome.
Psychogenic non-epileptic seizures (PNES), also referred to as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, are episodes resembling an epileptic seizure but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND) and are typically treated by psychologists or psychiatrists.
Non-epileptic seizures (NES), also known as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, are paroxysmal events that appear similar to an epileptic seizure, but do not involve abnormal, rhythmic discharges of neurons in the brain. Symptoms may include shaking, loss of consciousness, and loss of bladder control.
Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.
Infantile epileptic spasms syndrome(IESS) previously known as West syndrome needs the inclusion of epileptic spasms for diagnosis. Epileptic spasms (also known as infantile spasms) may also occur outside of a syndrome (that is, in the absence of hypsarrhythmia and cognitive regression) - notably in association with severe brain disorders (e.g. lissencephaly).
Alternating hemiplegia of childhood (AHC) is an ultra-rare neurological disorder named for the transient episodes, often referred to as "attacks", of hemiplegia that those with the condition experience. It typically presents before the age of 18 months. These hemiplegic attacks can cause anything from mild weakness to complete paralysis on one or both sides of the body, and they can vary greatly in duration. Attacks may also alternate from one side of the body to the other, or alternate between affecting one or both sides during a single attack. Besides hemiplegia, symptoms of the disorder include an extremely broad range of neurological and developmental impairments which are not well understood. Normally, hemiplegia and other associated symptoms cease completely with sleep, but they may recur upon waking.
GLUT1 deficiency syndrome, also known as GLUT1-DS, De Vivo disease or Glucose transporter type 1 deficiency syndrome, is an autosomal dominant genetic metabolic disorder associated with a deficiency of GLUT1, the protein that transports glucose across the blood brain barrier. Glucose Transporter Type 1 Deficiency Syndrome has an estimated birth incidence of 1 in 90,000 to 1 in 24,300. This birth incidence translates to an estimated prevalence of 3,000 to 7,000 in the U.S.
Benign Rolandic epilepsy or self-limited epilepsy with centrotemporal spikes is the most common epilepsy syndrome in childhood. Most children will outgrow the syndrome, hence the label benign. The seizures, sometimes referred to as sylvian seizures, start around the central sulcus of the brain.
Paroxysmal kinesigenic dyskinesia (PKD), also called paroxysmal kinesigenic choreoathetosis (PKC), is a rare hyperkinetic movement disorder of the paroxysmal dyskinesias characterized by attacks of involuntary movements, which are triggered by sudden voluntary movements. The number of attacks can increase during puberty and decrease in a person's 20s to 30s. Involuntary movements can take many forms such as ballism, chorea or dystonia and usually only affect one side of the body or one limb in particular.
Paroxysmal exercise-induced dystonia (PED) is a rare neurological disorder that belongs to the paroxysmal dyskinesias, a group of rare movement disorders that involve attacks of hyperkinesia with intact consciousness. It is characterized by sudden, transient, involuntary movements, often including repetitive twisting motions and painful posturing triggered by exercise or other physical exertion. The term paroxysmal indicates that the episodes are sudden and short lived and usually unpredicted, and return to normal is rapid. The number of reported cases of people with PED is very small leading to difficulty in studying and classifying this disease and most studies are limited to a very small number of test subjects.
Sleep-related hypermotor epilepsy (SHE), previously known as nocturnal frontal lobe epilepsy, is a form of focal epilepsy characterized by seizures which arise during sleep. The seizures are most typically characterized by complex motor behaviors. It is a relatively uncommon form of epilepsy that constitutes approximately 9-13% of cases. This disorder is associated with cognitive impairment in at least half of patients as well as excessive daytime sleepiness due to poor sleep quality. This disorder is sometimes misdiagnosed as a non-epileptic sleep disorder. There are many potential causes of SHE including genetic, acquired injuries and structural abnormalities.
Epilepsy is a neurological condition of recurrent episodes of unprovoked epileptic seizures. A seizure is an abnormal neuronal brain activity that can cause intellectual, emotional, and social consequences. Epilepsy affects children and adults of all ages and races, and is one of the most common neurological disorders of the nervous system. Epilepsy is more common among children than adults, affecting about 6 out of 1000 US children that are between the age of 0 to 5 years old. The epileptic seizures can be of different types depending on the part of the brain that was affected, seizures are classified in 2 main types partial seizure or generalized seizure.
Infantile convulsions and choreoathetosis (ICCA) syndrome is a neurological genetic disorder with an autosomal dominant mode of inheritance. It is characterized by the association of benign familial infantile epilepsy (BIFE) at age 3–12 months and later in life with paroxysmal kinesigenic choreoathetosis. The ICCA syndrome was first reported in 1997 in four French families from north-western France and provided the first genetic evidence for common mechanisms shared by benign infantile seizures and paroxysmal dyskinesia. The epileptic origin of PKC has long been a matter of debates and PD have been classified as reflex epilepsies. Indeed, attacks of PKC and epileptic seizures have several characteristics in common, they both are paroxysmal in presentation with a tendency to spontaneous remission, and a subset of PKC responds well to anticonvulsants. This genetic disease has been mapped to chromosome 16p-q12. More than 30 families with the clinical characteristics of ICCA syndrome have been described worldwide so far.
Epilepsy-intellectual disability in females also known as PCDH19 gene-related epilepsy or epileptic encephalopathy, early infantile, 9 (EIEE9), is a rare type of epilepsy that affects predominately females and is characterized by clusters of brief seizures, which start in infancy or early childhood, and is occasionally accompanied by varying degrees of cognitive impairment. The striking pattern of onset seizures at a young age, genetic testing and laboratory results, potential developmental delays or developmental regression and associated disorders, eases diagnosis.
An epilepsy syndrome is defined as "a characteristic cluster of clinical and Electroencephalography (EEG) features, often supported by specific etiological findings ."
Occipital epilepsy is a neurological disorder that arises from excessive neural activity in the occipital lobe of the brain that may or may not be symptomatic. Occipital lobe epilepsy is fairly rare, and may sometimes be misdiagnosed as migraine when symptomatic. Epileptic seizures are the result of synchronized neural activity that is excessive, and may stem from a failure of inhibitory neurons to regulate properly.