Neurology| December 01 2006 Panayiotopoulos Syndrome: A Benign Autonomic Epilepsy AAP Grand Rounds (2006) 16 (6): 69–70. https://doi.org/10.1542/gr.16-6-69-a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Panayiotopoulos Syndrome: A Benign Autonomic Epilepsy. AAP Grand Rounds December 2006; 16 (6): 69–70. https://doi.org/10.1542/gr.16-6-69-a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: digestive epilepsy Source: Covanis A. Panayiotopoulos syndrome: a benign childhood autonomic epilepsy frequently imitating encephalitis, syncope, migraine, sleep disorder, or gastroenteritis. Pediatrics. 2006;118:e1237–e1243; doi:10.1542/peds.2006-0623 Panayiotopoulos syndrome (PS) is described as a benign autonomic epilepsy that affects up to 13% of children aged 3–6 years (6% aged 1–15 years) with a history of nonfebrile seizures. The clinical features, electroencephalogram (EEG), misdiagnoses, and management of PS are reviewed by an investigator from the Sophia Children’s Hospital, Goudi, Athens, Greece. Emesis is the predominant manifestation of autonomic seizures in PS. Other autonomic symptoms include pallor, mydriasis, urinary or fecal incontinence, and hypersalivation. One-fifth of patients have ictal syncope with or without convulsions. One-half of the seizures last for >30 minutes, and constitute a nonconvulsive autonomic status. Two-thirds of the seizures occur during sleep. The EEG shows multiple spikes with occipital predominance, and occasionally centro-temporal spikes of benign Rolandic epilepsy. Prognosis is benign, with one-quarter of patients having a single seizure and half having 2 to 5 seizures during their lifetime. The remaining quarter have >6 seizures with remission occurring 1–2 years after onset. The risk of adult epilepsy seems to be no higher than in the general population.1 PS is often misdiagnosed, and is most commonly mistaken for acute encephalitis, syncope, migraine, benign Rolandic epilepsy, or gastroenteritis. Benzodiazepines are effective for terminating nonconvulsive autonomic status, and prolonged prophylactic antiepileptic medication (AEM) is prescribed infrequently. Aggressive treatment with large loading doses of AEM should be avoided because of the risk of cardiorespiratory arrest. Dr. Millichap has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device Dr. Tolia has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Vomiting as an ictal phenomenon has been described by various terms including ictus emeticus,2 diencephalic or autonomic epilepsy,3 abdominal epilepsy,4 and cyclic vomiting as a form of epilepsy.5 In reported cases of ictus emeticus, vomiting was induced by photic stimulation and was associated with oral automatisms, rhythmic chewing, and epigastric sensations. The EEG showed spikes in the right occipital lobe with spread to the right temporal lobe. Lateralization of the electroclinical manifestations of ictal vomiting to the right hemisphere, and occipito-temporal spikes in the EEG, similar to those mentioned with PS, are described by others.6 A review of autonomic epilepsies from hospitals in Boston found different manifestations in adults and children. In addition to gastrointestinal symptoms and complex partial seizures, adults may present with cardiovascular manifestations, sudden cardiac death, neurogenic pulmonary edema, and other respiratory symptoms. In children, ictal autonomic symptoms may be limited to visceral sensations, vomiting, and abdominal epilepsy. In 33 children presenting with cyclic vomiting, 7 (21%) had a previous history of generalized... You do not currently have access to this content.