Panayiotopoulos syndrome (PS) is a recognized childhood epilepsy syndrome with an unusual seizure semiology in normal children1. Seizures occur with prominent autonomic symptoms lasting for ½ hour or longer. Migraine and cyclical vomiting syndrome may be diagnosed though when syncope, hemiclonic, or convulsive seizures are noted the association with seizures become clarified. EEG in patients with PS shows marked variability in terms of location and an EEG may be normal further hampering clinical recognition. When seen, occipital spikes predominate and are typically of high voltage (figure A). Seizures may show shifting onsets with scalp recording from anterior to posterior onset (figure B) though with similar clinical manifestations. The prolonged duration is characteristic and has been recognized as autonomic status epilepticus. The neuropsychological examination is normal excepting visual and visuoperceptual alterations and infrequently minor attention and memory disturbances2. Most patients have < 5 seizures though about 5% are recurrent. Treatment is usually not required and CBZ or VPA have been used. Prognosis is excellent and most remit in several years. An earlier age may be a negative predictor and our patient is now seizure free and off AEDs.
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