PANAYIOTOPOULOS SYNDROME

Overview
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Seizure Classification
Generalized onset seizure
- Motor Onset
- Non-Motor Onset
Focal Onset Seizure
- By Onset Feature
- Focal to Bilateral Tonic-Clonic
- Hemispheric lateralization
- Lobar localization
  - Frontal
  - Temporal
  - Parietal
  - Occipital
Unknown Onset Seizure
Epilepsy Classification
Generalized Epilepsy
Focal Epilepsy
Generalized and Focal Epilepsy
Unknown Epilepsy
Epilepsy Syndromes
Neonatal/Infantile
- Self-limited neonatal seizures and Self-limited familial neonatal epilepsy
- Self limited familial and non-familial infantile epilepsy
- Early myoclonic encephalopathy
- Ohtahara syndrome
- West syndrome
- Dravet syndrome
- Myoclonic epilepsy in infancy
- Epilepsy of infancy with migrating focal seizures
- Myoclonic encephalopathy in non-progressive disorders
- Febrile seizures plus, genetic epilepsy with febrile seizures plus
Childhood
- Epilepsy with myoclonic-atonic seizures
- Epilepsy with eyelid myoclonias
- Lennox-Gastaut syndrome
- Childhood absence epilepsy
- Epilepsy with myoclonic absences
- Panayiotopoulos syndrome
- Childhood occipital epilepsy (Gastaut type)
- Photosensitive occipital lobe epilepsy
- Childhood epilepsy with centrotemporal spikes
- Atypical childhood epilepsy with centrotemporal spikes
- Epileptic encephalopathy with continuous spike-and-wave during sleep
- Landau-Kleffner syndrome
- Autosomal dominant nocturnal frontal lobe epilepsy
Adolescent/Adult
- Juvenile absence epilepsy
- Juvenile myoclonic epilepsy
- Epilepsy with generalized tonic-clonic seizures alone
- Autosomal dominant epilepsy with auditory features
- Other familial temporal lobe epilepsies
Any Age
- Familial focal epilepsy with variable foci
- Reflex epilepsies
- Progressive myoclonus epilepsies
Epilepsy Etiologies
Genetic Etiology
- Chromosomal abnormalities
- Gene abnormalities
Structural Etiology
- Malformations of cortical development
- Vascular malformations
- Hippocampal sclerosis
- Hypoxic-Ischemic
- Traumatic brain injury
- Tumors
- Porencephalic Cyst
Metabolic Etiology
Immune Etiology
- Rasmussen syndrome
- Antibody mediated
Infectious Etiology
Unknown Etiology
- Febrile infection related epilepsy syndrome
Epilepsy imitators

PANAYIOTOPOULOS SYNDROME

Background

The background EEG is normal.

CAUTION Focal slowing consistently over one area is not seen right arrow consider structural brain abnormality.

CAUTION Generalized slowing is not seen except in post-ictal periods.

Interictal

A single routine EEG is normal in 10% of patients. Multifocal high voltage repetitive spikes or sharp and slow-waves are seen in 90% of patients, these often are present in different focal areas on sequential EEGs. All focal brain regions may be affected but abnormality in posterior regions is common, with occipital spikes seen on EEG in 60% of patients. Low voltage spikes and generalized discharges may be seen in a minority of cases.

eeg
Example of multifocal spikes in Panayiotopoulos syndrome.

eeg
Example of occipital (left) spikes of high amplitude in Panayiotopoulos syndrome.

Activation

Eye closure (elimination of central vision and fixation off sensitivity) may activate occipital spikes. EEG abnormality is enhanced by sleep deprivation and by sleep, when discharges often have a wilder field and may be bilaterally synchronous.

Ictal

Ictal patterns are unilateral, often having posterior onset, with rhythmic slow (theta or delta) activity intermixed with small spikes.