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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.

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