Video-EEG documented lengthy seizure in Panayiotopoulos syndrome: clinical manifestations may be inconspicuous.

A 4-year-old boy had an autonomic seizure of Panayiotopoulos syndrome during video-EEG recording. Interictal EEG showed multifocal spikes in the centrotemporal and left posterior regions. Ictal electrographic onset included fast rhythms in the left posterior regions progressing to a mixture of high-amplitude spikes and fast and slow rhythms, bilaterally. The clinical symptoms (sighing, arousal with eyes opening, eye-deviation, and emesis with possible alteration of consciousness) started two minutes after the electrographic onset. These symptoms were mild and their characterisation as epileptic seizure behaviour would have been difficult without the ictal EEG documentation. The clinical manifestations of the child's previous epileptic seizures were mainly from the Rolandic area. [Published with video sequences].