Makindo Medical Notes

Related Subjects: |Encopresis in Children |Enuresis/Bedwetting in Children |Acute Glomerulonephritis in Children |Nephrotic Syndrome in Children |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Panayiotopoulos Syndrome in Children |Reflex anoxic attacks in Children

🧠 Introduction

• Panayiotopoulos syndrome is a benign, self-limiting focal epilepsy of childhood characterised by seizures with prominent autonomic features.
• Good prognosis ✅ – spontaneous remission usually occurs within 1–2 years of onset.
• Reassurance of parents is a key part of management, as seizures may look dramatic but do not cause long-term damage.
• Occurs in early to mid-childhood, with peak incidence around age 5.
• Accounts for about 6% of childhood epilepsies.

📌 Clinical Features

• Age of onset: Usually 1–8 years (peak ~5 years).
• Seizure characteristics:
  • Often occur during sleep/nighttime 🌙.
  • Autonomic symptoms are key: vomiting (most common), pallor, eye/head deviation, pupillary changes, incontinence, and sometimes cardiorespiratory changes.
  • Impaired awareness may precede convulsions (generalised tonic-clonic seizure may follow).
• Duration: Many seizures last 20–30 minutes ⏳, and some may progress to autonomic status epilepticus (hours) – but without permanent brain injury.
• Typical “triad”: Vomiting + eye deviation + unresponsiveness before convulsion onset.

🧾 EEG Findings

• Multifocal spikes – often shifting between regions.
• Occipital predominance is common but not universal (may also involve frontal/temporal areas).
• EEG abnormalities can persist even when seizures remit.

🔍 Diagnosis

• Diagnosis is largely clinical based on seizure description and autonomic features.
• EEG supports the diagnosis with shifting/multifocal spikes (often occipital).
• Important to exclude other causes of prolonged seizures or vomiting episodes (e.g., CNS infection, migraine, metabolic disorder).
• Detailed history and neuro exam remain essential 🩺.

📊 Prognosis

• Excellent prognosis ✅.
• Most children outgrow the condition within 1–2 years of first seizure.
• No long-term neurological deficits or cognitive impairment.
• Parents should be reassured that seizures, while frightening, are not damaging.

💊 Treatment

• Usually not required – most children do not need daily antiepileptic drugs (AEDs).
• Rescue treatment: Buccal midazolam or rectal diazepam may be used for prolonged seizures (>5 minutes).
• AEDs: Consider if seizures are very frequent, prolonged, or distressing (e.g., carbamazepine, valproate, levetiracetam).
• Parent education: Training in seizure first aid and reassurance are often more important than medication.

📌 Teaching Pearls

• Panayiotopoulos syndrome is sometimes called an “autonomic epilepsy” due to its prominent vegetative symptoms.
• Vomiting at seizure onset is highly characteristic.
• EEG spikes are often occipital but may migrate → “multifocal tendency.”
• Differentials: Gastroenteritis with febrile seizures, migraine with aura, or encephalitis.

✅ Conclusion

Panayiotopoulos syndrome is a benign childhood focal epilepsy marked by nocturnal seizures with autonomic symptoms (especially vomiting and eye deviation). Despite often prolonged and dramatic seizures, prognosis is excellent, with most children achieving remission without treatment. The mainstay of management is parental reassurance, education, and rescue medication for prolonged seizures.