September 27, 2019

EEG Recordings May Be Crucial in Diagnosis of Difficult-to-Diagnose Panayiotopolous Epileptic Syndrome


  • Panayiotopoulos syndrome (PS) is a frequent and benign epileptic syndrome.
  • It is characterized by isolated or predominantly long-lasting autonomic symptoms.
  • PS can be extremely insidious because it can imitate common nonepileptic conditions.
  • Consequences are misdiagnosis, mismanagement, and stress for children and parents.
  • The availability of EEG recording in pediatric emergency department could be crucial.


Panayiotopoulos syndrome (PS) is a frequent (6% among children of 1–15 years) and benign epileptic syndrome, characterized by predominantly autonomic symptoms (emesis, pallor, flushing, cyanosis, mydriasis/miosis, cardiorespiratory and thermoregulatory alterations, incontinence of urine and/or feces, hypersalivation, and modifications of intestinal motility) associated with simple motor focal seizures, which can be followed by secondary generalization. Panayiotopoulos syndrome can be extremely insidious, because it can mimic several condition, such as gastroenteritis, gastroesophageal reflux disease, encephalitis, syncope, migraine, sleep disorders, or even metabolic diseases. This peculiar pleiotropism should be kept in mind by child neurologists and pediatricians and general practitioners, because a wrong diagnosis may lead to inappropriate interventions. The consequences are high morbidity, costly mismanagement, and stress for children and their parents.

The availability of electroencephalography (EEG) recording in pediatric Emergency Departments might be useful for a prompt and not-cost-consuming diagnosis. On the other hand, it is important to be aware of the possible, multifaceted, clinical presentations of PS and its clinical, radiological, and neurophysiological features in order to improve both recognition and management.

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