Apparent life-threatening episodes (ALTE) can be the first manifestation of an epileptic seizure in children. However, the diagnosis of ALTE is generally delayed because the interictal EEG often appears normal and the presence of gastroesophageal reflux may mislead the diagnosis of the epileptic manifestation. We report 6 children with epilepsy who presented an ALTE as their first seizure manifestation. The retrospective analysis of our cases demonstrated that ictal EEGs, when available, appeared to be the most helpful test to confirm the diagnosis, although an abnormal-appearing cerebral imaging was also contributive in the patients when only interictal EEGs were available.
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