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Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 135

Gratification Disorder – A Seizure Mimicker

Department of Pediatrics, Government Medical College, Patiala, Punjab, India

Date of Submission04-Mar-2021
Date of Decision06-May-2021
Date of Acceptance07-May-2021
Date of Web Publication31-May-2021

Correspondence Address:
Dr. Shagun Walia
House Number 16 – A Defence Colony, Lane 1, Patiala - 147 001, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ipcares.ipcares_79_21

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How to cite this article:
Singh H, Walia S, Kaur B. Gratification Disorder – A Seizure Mimicker. Indian Pediatr Case Rep 2021;1:135

How to cite this URL:
Singh H, Walia S, Kaur B. Gratification Disorder – A Seizure Mimicker. Indian Pediatr Case Rep [serial online] 2021 [cited 2023 Apr 1];1:135. Available from: http://www.ipcares.org/text.asp?2021/1/2/135/317370

A 1.5-year-old developmentally normal girl presented with paroxysmal movements lasting for 1–2 min, every 2–3 days for a few weeks. The neurodevelopmental examination was normal. The events [Figure 1] and web [video 1] revealed posturing of the lower limbs with asymmetrical adduction and flexion of the hips, flexion and fisting of the left arm, intermittent neck flexion, and right striatal toe. Consciousness remained intact and the movements could be aborted by distraction. The differential diagnoses included gratification behavior, seizures, and dystonia. Unimpaired consciousness, absence of typical semiology, and distractibility ruled out seizures. The following features were in favor of a gratification disorder, instead of a movement disorder: presence of neck flexion, rather than tonic extension; continued exertion of perineal pressure in the absence of lower limb dystonias on sitting upright; and cessation with distraction.
Figure 1: Typical posture of the child during the event

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[Additional file 1]

This disorder is often misdiagnosed as seizures, dystonia, or abdominal pain leading to unnecessary investigations and treatment.[1] It peaks between 3 and 36 months of age and presents with stereotyped episodes encompassing vocalizations, grunting, facial flushing, diaphoresis, and perineal pressure with characteristic posturing of the lower extremities. Masturbatory activity may be difficult to recognize in young children as manual genital stimulation is usually absent.[2] The child is distractable[3] and may express displeasure when interrupted.[2] Examination and investigations are normal.[3] Video recording helps in understanding the nature of the event.[1],[2],[3] Sexual abuse and perineal irritation should be ruled out.[3]

Parental education is the cornerstone for management. Most children outgrow gratification behavior by 7 years of age.[1] Behavior modification strategies such as distraction and firm instruction to avoid such behavior without reprimand or harsh discipline have successful outcomes.[1]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Pandurangi AA, Pandurangi SA, Mangalwedhe SB, et al. Gratification behavior in a young child: Course and management. J Sci Soc 2016;43:48-50.  Back to cited text no. 1
  [Full text]  
Nechay A, Ross LM, Stephenson J, et al. Gratification disorder (”infantile masturbation”): A review. Arch Dis Child 2004;89:225-6.  Back to cited text no. 2
Yang ML, Fullwood E, Goldstein J, et al. Masturbation in infancy and early childhood presenting as a movement disorder: 12 cases and a review of the literature. Pediatrics 2005;116:1427-32..  Back to cited text no. 3


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