Abstracts

Rationale: To analyze initial EEG characteristics and sequential changes and to test whether correlation with clinical features exist in patients with Panayiotopoulos syndrome (PS). Methods: Methods Twenty-six (12 males, 14 females) patients, who had been followed up at least over 1 year with two or more sequential EEG recordings, were enrolled from September 2004 to June 2008. Medical and EEG records were reviewed. Patients showing other than occipital focus or normal EEG were included if autonomic symptoms were main features of seizures. Results: Vomiting (25/26, 96%) and syncope-like hyopotonia (17/26, 68%) were the most frequent ictal autonomic manifestations. Mean age at seizure onset was 6.0 years (3.1-12.5). Seizures frequently occurred nocturnal (14/26, 55%) and prolonged over 20 minutes (11/26, 44%). Mean seizure frequency was 3.5 (1-12) during mean 3.0 years (1-4.5) of follow-up. Seven patients (27%) experienced previous or concomitant febrile seizures. In three patients, the manifestations of febrile seizures were similar to their autonomic seizures. Familial occurrence of PS in the first-degree relatives was indentified in three patients. EEG at diagnosis could be classified as several groups: predominant occipital spikes in 13 (50%), focal spikes at other area in 4 (15%), generalized discharges with or without focal spikes in 4 (15%), normal in 5 (19%). Sequential EEG records revealed only 5 patients had constant and persistent focus. EEG focus changed in 10 patients without any specific direction. When compared between occipital spikes and other groups, no clinical differences existed except more frequent association of eyeball deviation and nocturnal occurrences in occipital spikes group. Conclusions: This study reinforce the concept of PS extending beyond occipital epilepsy by demonstrating variable and widely spread epileptogenic foci. Familial occurrence and relation to atypical febrile seizures warrant further genetic research.