Panayiotopoulos syndrome, also known as early-onset benign childhood occipital epilepsy, is a frequent electroclinical syndrome that often affects children between the ages of 3 and 7. It is characterized by seizures that are typically prolonged, with mostly autonomic symptoms, and by an EEG that displays shifting and/or numerous foci, often with occipital predominance.”
The manifestations, diagnostic criteria, outcomes, and results of these epileptic syndromes are distinct. Different manifestations of this syndrome can create diagnostic difficulties. Epileptic patients have a far greater mortality rate than healthy people. Sudden unexpected death in epilepsy) is a common epilepsy-related cause of mortality, though it is not as prevalent in children as it is in adults.
Panayiotopoulos Syndrome Triggers
Panayiotopoulos syndrome is characterized by an increased susceptibility to autonomic seizures beginning in infancy or early childhood and manifesting as electroencephalographic occipital or extra occipital spikes.
Panayiotopoulos syndrome usually manifests between the ages of one and three, however, it can also appear between one and fourteen. Generally, seizures occur during sleep, with autonomic and behavioral characteristics predominating. These include tonic eye deviation, pallor, sweating, agitation, and nausea. One-third of individuals have seizures that continue for many hours. Seizures are uncommon, and the prognosis is favorable, with remission occurring within one to two years.
Panayiotopoulos Syndrome EEG Rate
Clinical symptoms as well as the findings of an EEG are used to make a diagnosis of PS. Imaging tests, such as MRI or CT scans, do not typically reveal significant results and are not used to make the actual diagnosis; however, they can be helpful in the differential diagnosis. Ictal epileptiform discharges can signal the beginning of an EEG recording of a seizure. At the peak of seizure activity, the discharges advance from rapid, uninterrupted spikes and waves to numerous spikes accompanied by buried waves, with an increase in frequency.
In the posterior quadrants of the interictal EEG, there are runs of high amplitude 2-3 Hz sharp and slow wave complexes. Many kids exhibit frontal or centrotemporal spikes. In Panayiotopoulos syndrome, the EEG shows posterior slowing during ictal activity.
Idiopathic photosensitive occipital epilepsy in children typically manifests between the ages of 5 and 17. Seizures are induced by television and video games.
Occipital epileptiform activity is visible in the ictal EEG and can move from one side to the other.
Panayiotopoulos Syndrome Symptoms
PS is marked by focal seizures that happen rarely and are followed by autonomic symptoms like throwing up and changes in behavior. This syndrome typically manifests as an episode in which the kid is conscious and complains of discomfort and nausea appears pale, and may vomit, accompanied by head and eye deviation. The emetic triad, consisting of nausea, vomiting, and retching is the most prevalent symptom. Respiratory episodes and cardiac arrhythmias are common, but cardiorespiratory arrest is described in a few cases.
The child also loses consciousness in some cases and develops generalized tonic-clonic seizures. The majority of events happen while a child is sleeping at night or taking a quick nap during the day, and in both cases, the child wakes up with the same reports and symptoms. After experiencing the most acute symptoms, the child can return to a normal state after a brief period of postictal sleep; this aids in diagnosis and reassures the parents.
Panayiotopoulos Syndrome Causes
Panayiotopoulos syndrome is a benign childhood seizure susceptibility syndrome. This syndrome is brought on by an innate autonomic instability, which, when triggered by cortical hyperexcitability in brain circuits that are vulnerable to it, causes autonomic seizures. Panayiotopoulos syndrome is triggered by epileptogenic activation of a low threshold central autonomic area, but the impulses are too weak to activate the cortical areas that often induce motor or sensory signs.
Panayiotopoulos Syndrome Treatment
PS is a frequent form of pediatric epilepsy that typically has a positive outcome and resolves on its own. Children with PS frequently experience few seizures, making anti-seizure medicine unnecessary.
When seizures occur more frequently, they can be controlled by anti-seizure drugs such as:
- Carbamazepine (Tegretol or Carbatrol).
- Oxcarbazepine (Trileptal).
- Zonisamide (Zonegran).
- Lacosamide (Vimpat).
- Gabapentin (Neurontin.
- Levetiracetam (Keppra).
Seizures in children with PS can last for a long time, perhaps necessitating immediate medical attention. It is also recommended to use a rescue medication like diazepam rectal gel or another kind of benzodiazepine injected under the tongue, between the cheek and gum, or through the nose. Most doctors would recommend antiepileptic medication such as valproic acid, clobazam, or carbamazepine after the patient has experienced two or more seizures.