Ictal video-polysomnography and EEG spectral analysis in a child with severe Panayiotopoulos syndrome
Pasquale Parisi1, Raffaele Ferri, Jacopo Pagani
1Child Neurology Unit, University of Rome, Sant'Andrea Hospital, Rome. parpas@iol.it
Insights
This study details the polysomnographic findings of a patient with Panayiotopoulos syndrome, an epilepsy characterized by prolonged nocturnal seizures with autonomic symptoms. The analysis revealed complex ictal patterns originating in the occipital lobe, offering new insights into this rare condition.
Area of Science:
- Neurology
- Epileptology
- Clinical Neurophysiology
Background:
- Panayiotopoulos syndrome is a rare, benign childhood epilepsy with infrequent, prolonged nocturnal seizures.
- Autonomic symptoms like nausea and vomiting are characteristic, but ictal EEG data are scarce.
- Limited information exists on specific autonomic manifestations, such as tachycardia, during seizures.
Observation:
- A single all-night videopolysomnography captured one seizure event.
- Quantitative spectral analysis of the video-EEG data was performed.
- The seizure exhibited a focal onset in the right occipital area.
Findings:
- The ictal EEG showed complex cortical involvement, spreading to widespread extra-occipital regions.
- The patient presented with atypical features, including frequent seizures and post-ictal headache.
- Late-onset visual hallucinations were noted, a feature more common in Gastaut-type epilepsy.
Implications:
- This case provides valuable ictal EEG insights into Panayiotopoulos syndrome, particularly its occipital onset.
- Understanding these patterns aids in differentiating it from other childhood occipital epilepsies.
- Further research is needed to clarify the spectrum of clinical and EEG presentations in this syndrome.
Objective:
To describe the ictal polysomnographic features of a patient with Panayiotopoulos syndrome, a peculiar epileptic syndrome characterized by infrequent, often single, prolonged, nocturnal, focal seizures comprising an unusual constellation of autonomic symptoms (malaise, nausea, pallor, tachycardia, vomiting) and unilateral deviation of the eyes at the onset of seizures. These clinical, ictal manifestations are rarely followed by post-ictal headache. In the literature, there is little information on the ictal EEG characteristics of Panayiotopoulos syndrome and, in particular, on certain autonomic manifestations, such as tachycardia, as the sole ictal phenomena at the onset of seizures.
Methods And Results:
One, all-night videopolysomnography, during which one seizure was recorded. Video-EEG data were evaluated visually and by means of quantitative spectral analysis. The spectral analysis of the recorded seizure showed a complex ictal pattern of cortical involvement with focal onset in the right occipital area followed by the recruitment of widespread extra-occipital cortical regions.
Conclusions:
This is the first such analysis of this peculiar epileptic condition. Most of the symptoms were consistent with a diagnosis of severe Panayiotopoulos syndrome, although the patient also presented "atypical findings": a relatively high frequency of seizures, post-ictal headache, no spontaneous remission of seizures with age, and late onset of visual hallucinations; this last finding is more frequent in "Gastaut-type childhood occipital epilepsy", in which onset typically occurs later than in Panayiotopoulos syndrome. [Published with video sequences].
