Here we present a 3½-year-old male child with Panayiotopoulos syndrome who presented with status epilepticus and ictal cardiorespiratory arrest requiring cardiopulmonary resuscitation for revival. [ncbi.nlm.nih.gov]

• Enuresis

  Patient 3, an 8-year-old boy, had a history of restless legs at night, enuresis, night terrors, visual hallucinations, cyclic abdominal pain, and nausea. His EEG showed bitemporal spikes. [ncbi.nlm.nih.gov]

• Collapse

  A 7-year-old boy had from 5 years of age approximately 12 episodes of collapse at school. All episodes were stereotyped but of variable duration from 2 to 35 minutes. [en.wikipedia.org]

• Respiratory Abnormalities

  This case also illustrates the features of syncope-like epileptic seizures together with other variable autonomic symptoms (emesis, respiratory abnormalities, pallor, mydriasis) in Panayiotopoulos syndrome. [en.wikipedia.org]

• Sighing

  The clinical symptoms (sighing, arousal with eyes opening, eye-deviation, and emesis with possible alteration of consciousness) started two minutes after the electrographic onset. [ncbi.nlm.nih.gov]

• Pharyngitis

  As already mentioned 2,4,9-12 some cases (22.2%) were observed involving only a single seizure, in which the autonomic symptomatology was followed by oro-pharyngeal manifestation, characteristics suggesting the overlapping of two benign childhood epilepsies [scielo.br]

• Recurrent Vomiting

  At age 4 years, two episodes of recurrent vomiting, tonic eye deviation and consciousness impairment lasting for about 30 min occurred. [ncbi.nlm.nih.gov]

• Dyspepsia

  On all previous occasions the diagnosis varied from psychosomatic disease, to functional dyspepsia, to cyclic vomiting syndrome. The possibility of autonomic epileptic seizures and Panayiotopoulos syndrome, though likely, was not considered. [ncbi.nlm.nih.gov]

• Flushing

  Occasionally, these seizures can present with prominent autonomic features such as ictal vomiting, pallor, flushing/cyanosis, and tachycardia with prolonged thermoregulatory changes lasting for hours, constituting autonomic status epilepticus. [ncbi.nlm.nih.gov]

  Other autonomic manifestations include pallor (or, less often, flushing or cyanosis), mydriasis (or, less often, miosis), cardiorespiratory and thermoregulatory alterations, incontinence of urine and/or feces, hypersalivation, and modifications of intestinal [doi.org]

• Miosis

  Concurrent autonomic symptoms during AS SLES included emesis, incontinence, mydriasis, miosis, and cardiorespiratory abnormalities. [ncbi.nlm.nih.gov]

  Other autonomic manifestations include pallor (or, less often, flushing or cyanosis), mydriasis (or, less often, miosis), cardiorespiratory and thermoregulatory alterations, incontinence of urine and/or feces, hypersalivation, and modifications of intestinal [doi.org]

• Lacrimation

  Patient 1, a 12-year-old girl, had a history of involuntary lacrimation, abdominal pain, and recurrent episodes of loss of muscle tone and unresponsiveness followed by somnolence. Her EEG revealed bilateral frontotemporal spikes. [ncbi.nlm.nih.gov]

• Suggestibility

  Abilities involving attention were normal for all patients, suggesting that inattention is not responsible for these visual deficits. [ncbi.nlm.nih.gov]

• Chronic Anxiety

  The decision should also take into account a likely traumatising parental experience as in febrile convulsions. 3, 4, 8 Appropriate advice by the family doctor is expected to shape parental attitude and prevent chronic anxiety. [ncbi.nlm.nih.gov]

• Episodic Headache

  Patient 2, a 10-year-old boy, had episodic headaches with pinpoint pupils, skin flushing of the face, trunk, and extremities, purple discoloration of hands and feet, diaphoresis, nausea, and vomiting. [ncbi.nlm.nih.gov]

• Cerebral Calcification

  • Celiac disease, epilepsy, and cerebral calcification syndrome (check anti-gliadin antibodies). • Migraine with visual aura. Migraine with visual aura. [medlink.com]

• Involuntary Movements

  The latter occurred in 7 children suddenly and without premonition or obvious triggers while standing, sitting, lying down, or asleep, did not resolve in the horizontal position, and were not associated with stiffening or any involuntary movements, even [ncbi.nlm.nih.gov]

• Flaccid Paralysis

  Paralysis: A case report Ito K，Fujita T，Watanabe E，Ihara Y，Ideguchi H，Morishita T, Inoue T，Inoue T, Hirose S, AOCCN2017 14th Asian and Oceanian Congress of Child Neurology, 2017年5月 The effectiveness of steroid pulse therapy and prognosis in frontal lobe [resweb2.jhk.adm.fukuoka-u.ac.jp]

We describe a young girl with intractable and lengthy vomiting attacks, several admissions to hospitals, and extensive gastroenterological workup for several years from early childhood. [ncbi.nlm.nih.gov]

Sleep can facilitate the appearance of spike-wave discharges DIAGNOSTIC WORKUP PowerPoint Presentation: Therapy for epilepsy with myoclonic-astatic seizures in early childhood remains empirical. [authorstream.com]

This requires extensive workup with detailed brain imaging and EEGs. A neurosurgeon will then surgically remove the area of the brain that is causing the seizures. This is called epilepsy surgery. [childneurologyfoundation.org]

If the patient has the typical clinical history and EEG findings and has normal findings on neurologic examination, further workup is not indicated. [emedicine.medscape.com]

• Multifocal Spikes

  Interictal EEG showed multifocal spikes in the centrotemporal and left posterior regions. [ncbi.nlm.nih.gov]

• Occipital Sharp-and-Slow-Waves

  The electroencephalogram manifestations are severe with long runs of high amplitude occipital sharp and slow waves. [adc.bmj.com]

  Both syndromes share similar classical inter-ictal EEG features with runs of occipital sharp and slow wave complexes which attenuate on eye opening (Panayiotopoulos, 1981 ). [academic.oup.com]

• Multifocal Discharges

  Sequential EEGs obtained from 5 to 11 years of age showed both multifocal discharges and generalized spike and wave complexes. With these changes in EEG findings, the patient experienced various types of seizures. [ncbi.nlm.nih.gov]

   EEG shows multifocal discharges, typically rhythmic theta activity, that progressively expand to adjacent cortical areas  Ictal and interictal EEGs become indistinguishable  Prognosis is poor 12.  Onset before 1 year, peak 4–7 months.  Clusters [slideshare.net]

• Irregular Generalized Spike-and-Slow-Waves

  An outpatient EEG 6 months later showed abundant multifocal, predominantly posterior, as well as irregular generalized spike-and-slow-wave discharges on normal background consistent with the diagnosis of Panayiotopoulos syndrome. [ncbi.nlm.nih.gov]

• Multifocal Epileptiform Discharges

  Multifocal epileptiform discharges on EEG were identified in 84% of the patients. Two or more antiepileptic drugs were required in only 13% of the patients. [ncbi.nlm.nih.gov]

Considerable international variation in management and controversy about non-treatment indicate the need for high quality randomised controlled trials (RCT). [ncbi.nlm.nih.gov]

Adjunctive treatment in children, young people and adults with Lennox–Gastaut syndrome Do not offer carbamazepine, gabapentin, oxcarbazepine, pregabalin, tiagabine or vigabatrin. [nice.org.uk]

PURPOSE: To determine prevalence, clinical, EEG features, and prognosis of Panayiotopoulos syndrome and to examine the proposition that clinical manifestations are more important than EEG findings. [ncbi.nlm.nih.gov]

If an infectious or a metabolic etiology is suspected, laboratory tests can also be helpful. [amboss.com]

Other types defined by location and etiology Neocortical epilepsies Rasmussen syndrome Other types defined by location and etiology Syndromes in development PowerPoint Presentation: CONDITIONS WITH EPILEPTIC SEIZURES THAT DO NOT REQUIRE, A DIAGNOSIS [authorstream.com]

Introduction Occipital epilepsies commonly start in childhood or adolescence and include two etiologic groups: Symptomatic and idiopathic epilepsies. [neupsykey.com]

[…] return to baseline LOC Refractory status epilepticus – seizure lasting 1h or refractory to 2 appropriate AEDs Engel classification Axis 1 – ictal phenomenology Axis 2 – seizure type, focal origin, precipitating stimuli Axis 3 – epilepsy syndrome Axis 4 – etiology [emilytam.com]

It is broadly recognized that the individual prognosis of epilepsy reflects primarily its underlying etiology and syndromic classification. [bmcneurol.biomedcentral.com]

Thirty-seven medical records of patients diagnosed with PS were reviewed and the epidemiological and clinical features, results of complementary studies and evolutional data were collected. Mean age at diagnosis was 5.4 years. [ncbi.nlm.nih.gov]

EPIDEMIOLOGY. Panayiotopoulos syndrome probably affects 13% of children aged 3 to 6 years who have had 1 or more afebrile seizures and 6% of such children in the 1- to 15-year age group. DIAGNOSTIC TESTS. [doi.org]

This is a critical review of the clinical and EEG features of PS, focusing on those characteristics that may shed some light on its so far elusive pathophysiology. [ncbi.nlm.nih.gov]

Knowing that an autonomic manifestation during fever can be an epileptic seizure could facilitate diagnosis and prevent unnecessary investigations and erroneous treatments. [ncbi.nlm.nih.gov]

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