Documentation of autonomic seizures and autonomic status epilepticus with ictal EEG in Panayiotopoulos syndrome

Area of Science:

• Neurology
• Epileptology
• Pediatric Neurology

Background:

• Panayiotopoulos syndrome (PS) is a prevalent childhood epilepsy syndrome characterized by autonomic seizures and status epilepticus.
• Despite its high prevalence, the underlying pathophysiology and EEG characteristics of PS have been debated.
• Understanding the electrophysiological basis of PS is crucial for accurate diagnosis and management.

Observation:

• This study presents ictal electroencephalogram (EEG) documentation of autonomic seizures and autonomic status epilepticus in six PS cases.
• A review of 14 previously reported cases was also conducted.
• Interictal EEGs revealed spikes with variable locations and temporal changes, while ictal EEG onsets were diverse, originating from anterior or posterior regions.

Findings:

• Ictal EEG onsets in PS were multifocal, often showing theta waves mixed with spikes and fast rhythms.
• Autonomic manifestations like vomiting and eye deviation did not correlate with specific EEG activation regions.
• The findings support PS as a multifocal autonomic epilepsy, with clinical symptoms arising from widespread epileptogenic foci.

Implications:

• These results challenge the notion of PS originating from a single focal point.
• The study supports the hypothesis that PS involves a hyperexcitable central autonomic network influenced by variable epileptogenic foci.
• This understanding may refine diagnostic criteria and treatment strategies for childhood epilepsy with autonomic features.