Stormy onset of benign childhood epilepsy with occipital paroxysmal discharges

Episodic vomiting and headache in children: consider occipital epilepsy

Children with occipital seizures often have ictal autonomic symptoms such as pallor and vomiting and lack motor manifestations. This has lead to misdiagnosis of occipital seizures in children. The following case report highlights the clinical features of a child with occipital epilepsy misdiagnosed as having migraine. The aetiology of symptomatic occipital epilepsy will be discussed.

Panayiotopoulos syndrome: a consensus view

The aim of this paper is to promote the correct classification of, and provide guidelines on, the diagnosis and management of Panayiotopoulos syndrome (PS). An international consortium of established researchers in the field collaborated to produce a consensus document. The resulting document defines PS, characterizes its electro-clinical features, considers its likely pathogenesis, and provides guidance on appropriate management. We conclude that PS is a common idiopathic, benign seizure disorder of childhood, which should be classified as an autonomic epilepsy, rather than an occipital epilepsy.

Spatially uniform and nonuniform analyses of electroencephalographic dynamics,with application to the topography of the alpha rhythm

Corticothalamic dynamics are investigated using a model in which spatial nonuniformities are incorporated via the coupling of spatial eigenmodes. Comparison of spectra generated using the nonuniform analysis with those generated using a uniform one demonstrates that, for most frequencies, local activity is only weakly dependent on activity elsewhere in the cortex; however, dispersion of low-wave-number activity ensures that distant dynamics influence local dynamics at low frequencies (below approximately 2 Hz ), and at the alpha frequency (approximately 10 Hz ), where propagating signals are inherently weakly damped, and wavelengths are large. When certain model parameters have similar spatial profiles, as is expected from physiology, the low-frequency discrepancies tend to cancel, and the uniform analysis with local parameter values is an adequate approximation to the full nonuniform one across the whole spectrum, at least for large-scale nonuniformities. After comparing the uniform and nonuniform analyses, we consider one possible application of the nonuniform analysis: studying the phenomenon of occipital alpha dominance, whereby the alpha frequency and power are greater at the back of the head (occipitally) than at the front. In order to infer realistic nonuniformities in the model parameters, the uniform version of the model is first fitted to data recorded from 98 normal subjects in a waking, eyes-closed state. This yields a set of parameters at each of five electrode sites along the midline. The inferred parameter nonuniformities are consistent with anatomical and physiological constraints. Introducing these spatial profiles into the full nonuniform model then quantitatively reproduces observed site-dependent variations in the alpha power and frequency. The results confirm that the frequency shift is mainly due to a decrease in the corticothalamic propagation delay, but indicate that the delay nonuniformity cannot account for the observed occipital increase in alpha power; the occipital alpha dominance is due to decreased cortical gains and increased thalamic gains in occipital regions compared to frontal ones.

Autonomic seizures and autonomic status epilepticus peculiar to childhood: diagnosis and management

Autonomic seizures and autonomic status epilepticus in children have a high prevalence, manifest with dramatic clinical symptoms, and have important clinical and management implications. They probably affect approximately 13% of children aged 3-6 years with one or more nonfebrile seizures, or 6% in the age group 1-15. The primary cause is an idiopathic age-dependent epileptogenic susceptibility (Panayiotopoulos syndrome), but 10-20% are due to cerebral pathology. Autonomic seizures and autonomic status epilepticus have been best studied in Panayiotopoulos syndrome, which has been confirmed worldwide in more than 800 cases and recently recognized in the new classification scheme of the International League Against Epilepsy. Seizures start with autonomic symptoms, mainly emesis, while the child is usually fully conscious. Other more conventional seizure manifestations often ensue, but autonomic manifestations commonly predominate to the end of the seizure. Ictal syncope (transient loss of consciousness and postural tone) is an intriguing common symptom. Half of the seizures last longer than 30 minutes, constituting autonomic status epilepticus. Prognosis is invariably excellent except for the symptomatic cases. The interictal EEG shows great variability from normal to severely epileptogenic, often with multifocal spikes. Pathophysiology of Panayiotopoulos syndrome is unknown, but it is likely that they are due to diffuse maturation-related epileptogenicity activating susceptible-for-children emetic centers and the hypothalamus. Thus, Panayiotopoulos syndrome is not occipital epilepsy, with which it is often erroneously equated. Autonomic seizures and autonomic status epilepticus are frequently misdiagnosed and often treated as encephalitis, atypical migraine, cardiogenic syncope, or other unrelated medical conditions such as gastroenteritis. This review examines the existing evidence, provides a means of improving diagnostic yield, and proposes practice parameters and guidelines for the diagnosis and management of autonomic seizures and autonomic status epilepticus in children.