{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:59:14Z","timestamp":1781254754361,"version":"3.54.1"},"reference-count":11,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Auditory\u2010triggered motor events in infancy present a significant diagnostic challenge due to overlap between epileptic and non\u2010epileptic startle phenomena. We report the case of a term female infant with neonatal\u2010onset seizures and subsequent development of reproducible sound\u2010triggered jerky movements, raising diagnostic uncertainty between exaggerated startle reflex and reflex auditory epilepsy. The child initially presented with seizures on the third day of life and was treated with phenobarbital. During early infancy, brief motor events consistently precipitated by sudden auditory stimuli were observed, later accompanied by spontaneous seizures and developmental plateauing. Serial electroencephalography (EEG) revealed evolution from focal frontotemporal interictal epileptiform discharges to multifocal epileptiform activity with marked sleep activation, while repeated brain magnetic resonance imaging remained structurally normal. Over time, global developmental delay with hypotonia and impaired motor milestones became evident. The electroclinical trajectory suggested an evolving epileptic encephalopathy within the epileptic encephalopathy with spike\u2013wave activation in sleep spectrum, despite the absence of a classic continuous spike\u2010and\u2010wave during sleep pattern. Whole\u2010exome sequencing identified a homozygous HEXA gene variant of uncertain significance, without definitive biochemical or clinical evidence of GM2 gangliosidosis. The child was managed with multiple antiseizure medications and supportive neurodevelopmental interventions, resulting in partial seizure control but persistent developmental impairment. This case underscores the importance of longitudinal electroclinical correlation in infants with stimulus\u2010triggered motor events and highlights that reproducible auditory\u2010induced events with evolving epileptiform EEG abnormalities and developmental impact strongly favor reflex auditory epilepsy over non\u2010epileptic exaggerated startle, even in the setting of normal neuroimaging and genetic uncertainty.<\/jats:p>","DOI":"10.1002\/ccr3.72594","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T04:42:21Z","timestamp":1776746541000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Dilemma in an Infant With Sound\u2010Triggered Motor Events: Reflex Epilepsy Versus Exaggerated Startle\u2014A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6222-3498","authenticated-orcid":false,"given":"Aakash","family":"Pandit","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Chitwan Medical College  Bharatpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melisha","family":"Koirala","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Chitwan Medical College  Bharatpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7901-8216","authenticated-orcid":false,"given":"Anil","family":"Shahi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Chitwan Medical College  Bharatpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupama","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Chitwan Medical College  Bharatpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aashish","family":"Panta","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Medical College  Birgunj Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuvra","family":"Rimal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Chitwan Medical College  Bharatpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/1086508X.2006.11079556"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2009.12.020"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780197634547.003.0003"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/08830738241273425"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.38082"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.4103\/0028\u20103886.338670"},{"key":"e_1_2_11_8_1","volume-title":"The Epilepsies: Seizures, Syndromes and Management","author":"Panayiotopoulos C. P.","year":"2005"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1684\/j.1950-6945.2003.tb00574.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528\u20101157.1995.tb01007.x"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/583531"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2023-256628"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72594","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.72594","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72594","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:39:38Z","timestamp":1781253578000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.72594"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":11,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/ccr3.72594"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.72594","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2026-01-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72594"}}