Panayiotopoulos syndrome and symptomatic occipital lobe epilepsy of childhood: a clinical and EEG study

Abstract

Aim. Panayiotopoulos syndrome (PS) is an age‐related seizure susceptibility syndrome that affects the central autonomic system. Although the majority of the few ictal recordings obtained so far suggest an occipital origin, semiological and interictal EEG data appear to favour more extensive involvement. In this study, the characteristics (including those based on semiology and EEG) of children with Panayiotopoulos syndrome (n=24) and those with lesion‐related, symptomatic occipital lobe epilepsy (SOLE) (n=23) were compared. Methods. Detailed semiological information and EEG parameters including the localisation, distribution, density (n/sec), reactivity, and morphological characteristics of spike‐wave foci and their relationship with different states of vigilance were compared between the two groups. Results. The age at seizure onset was significantly younger in patients with symptomatic occipital lobe epilepsy than in those with PS (mean age at onset: 3.4 versus 5.6 years, respectively; p=0.044). Autonomic seizures (p=0.001) and ictal syncope (p=0.055) were more frequent in PS than in symptomatic occipital lobe epilepsy (87.5% and 37.5% versus 43.5% and 13%, respectively). The interictal spike‐wave activity increased significantly during non‐rapid eye movement (non‐REM) sleep in both groups. The spike waves in non‐REM seen in PS tended to spread mainly to central and centro‐temporal regions. Conclusions. The results indicate that although common features do exist, Panayiotopoulos syndrome differs from symptomatic occipital lobe epilepsy and has a unique low epileptogenic threshold related to particular brain circuits.

The role of EEG in the diagnosis and classification of the epilepsy syndromes: a tool for clinical practice by the ILAE Neurophysiology Task Force (Part 2)

“…Occipital spikes may occur in paroxysms (for occipital paroxysms, see chapter on occipital epilepsy of Gastaut). The diagnostic sensitivity of the sleep EEG ranges from 80% to 100% (Ohtsu et al, 2003;Sanders et al, 2004;Tata et al, 2014). Multifocal spikes may occur over any area (frontal, central, parietal or temporal) and shift from one region to another and from side to side in a series of EEGs, while they may not be associated with occipital spikes.…”

Standard procedures for the diagnostic pathway of sleep‐related epilepsies and comorbid sleep disorders: A European Academy of Neurology, European Sleep Research Society and International League against Epilepsy‐Europe consensus review

“…Sensitivity of standard EEG for occipital spikes and extra-occipital spikes is reported to ~66% (Sanders, Rowlinson, Manidakis, Ferrie, & Koutroumanidis, 2004;Tata, Guveli, & Dortcan, 2014) with only one study (Caraballo, Cersósimo, & Fejerman, 2007) reporting higher levels (92.3%).…”

“…Sensitivity of sleep EEG (N1-N2 is sufficient for activation of spikes) is higher (78%-100%) (Lada, Skiadas, Theodorou, Loli, & Covanis, 2003;Ohtsu et al, 2003;Sanders et al, 2004;Tata et al, 2014). Specificity data not available.…”

“…Summary of the evidence Sensitivity of standard EEG for occipital spikes and extra‐occipital spikes is reported to ~66% (Sanders, Rowlinson, Manidakis, Ferrie, & Koutroumanidis, 2004; Tata, Guveli, & Dortcan, 2014) with only one study (Caraballo, Cersósimo, & Fejerman, 2007) reporting higher levels (92.3%). Sensitivity of sleep EEG (N1–N2 is sufficient for activation of spikes) is higher (78%–100%) (Lada, Skiadas, Theodorou, Loli, & Covanis, 2003; Ohtsu et al., 2003; Sanders et al., 2004; Tata et al., 2014). Specificity data not available.…”

Occipital Lobe

“…For example, vision with awareness is still possible in the whole visual field after loss of the occipital lobe of one or both cerebral hemispheres or after hemispherectomy in childhood (Werth 2006;Bova et al 2008). The occipital lobe as it relates to adolescence historically has been most frequently studied in the context of epilepsy, schizophrenia, and similar pathologies because these have been linked most clearly to relatively common adolescent mental illnesses for a long time (Tata et al 2014). Emerging research from the past few decades has explored the intersections of the occipital lobe with multisensory phenomena, physical pathologies of the lobe that can have troubling implications for adolescents, as well as the lobe's role in the performance of cognitive tasks.…”