title: Diffuse onset of ictal electroencephalography in a typical case of Panayiotopoulos syndrome and review of the literature.
abstract: Panayiotopoulos syndrome is a common and benign childhood autonomic epilepsy of debated localization. Although officially considered as occipital epilepsy, this is most likely of multifocal origin. Ictal electroencephalography is the gold standard of seizure localization, but in Panayiotopoulos syndrome, because patients have single or rare seizures, only 7 cases with ictal electroencephalography have been reported. Ictal onsets show variable anterior and more often posterior locations. We describe an 8-year-old girl with 5 nocturnal autonomic seizures typical of Panayiotopoulos syndrome from age 4. The last seizure was captured with electroencephalography and showed a diffuse onset of the ictal discharge, whereas various interictal electroencephalography had infrequent multifocal spikes. This case contributes to the understanding of the pathophysiology of Panayiotopoulos syndrome in favor of a diffuse and multifocal cortical epileptogenicity that triggers an unstable central autonomic nervous system solely or prior to the focal cortical symptoms.
authors.affiliation: Department of Pediatrics, Division of Child Neurology, La Sapienza University of Rome, Viale Regina Elena 324, Rome, Italy. paola.iannetti@uniroma1.it
authors.forename: Paola
authors.initials: P
authors.lastname: Iannetti
authors.forename: Alberto
authors.initials: A
authors.lastname: Spalice
authors.forename: Valerio
authors.initials: V
authors.lastname: Rocchi
authors.forename: Alberto
authors.initials: A
authors.lastname: Verrotti
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000503:physiopathology*; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology*; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006801:Humans; D009415:Nerve Net / Q000503:physiopathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012890:Sleep / Q000502:physiology; D014851:Wakefulness / Q000502:physiology