A newborn has fine, fast tremulous movements of the limbs that come on when the baby is handled or moved, and stop when the affected limb is gently held. There is no eye deviation or autonomic change. What is the most likely explanation?

Answer: D. Jitteriness (a non-epileptic mimic), not a seizure

Jitteriness versus seizure

Distinguishing non-epileptic movements from true seizures is challenging but important.

Features of jitteriness

• Stimulus-sensitive: comes on with movement/handling or a change of posture.
• Stops when the limb is held or the posture is changed.
• High-frequency, oscillatory, tremor-like movement (like a shiver), usually in the extremities.
• No eye deviation or autonomic changes (which can accompany true seizures).

Why these features point away from a seizure

True seizures are not provoked by handling and are not abolished by holding the limb, and may have ocular/autonomic features. Benign sleep myoclonus (brief myoclonic jerks in early NREM sleep that disappear on waking) is the other common mimic.

Why D

Stimulus-provoked tremor that stops on holding is jitteriness, a non-epileptic mimic.

Why the others are wrong

Focal clonic, tonic, myoclonic seizures and status epilepticus are true seizures - they are not stimulus-provoked or abolished by holding the limb.