The clinical features, EEG, misdiagnoses, and management of children with Panayiotopoulos syndrome (PS) are reviewed from Sophia Children’s Hospital, Goudi-Athens, Greece. Emesis is the predominant manifestation of autonomic seizures in PS. Other autonomic symptoms include pallor, mydriasis, urinary or fecal incontinence, and hypersalivation. One fifth have ictal syncope with or without convulsions. One half of the seizures last for >30 minutes, and constitute a nonconvulsive autonomic status. Two thirds of the seizures occur during sleep. The EEG shows multiple spikes, occipital predominating, and sometimes centro-temporal of Rolandic epilepsy. Prognosis is benign, one quarter of patients having a single seizure and half having 2 to 5 seizures. One fifth develop Rolandic or occipital seizures, remitting before age 16 years. Cardiorespiratory arrest during an autonomic seizure is a very rare occurrence. Misdiagnoses include acute encephalitis, syncope, migraine, benign Rolandic epilepsy, or gastroenteritis. Benzodiazepines are used to terminate nonconvulsive autonomic status, and prophylactic treatment is prescribed infrequently. Aggressive treatment is avoided because of risk of cardiorespiratory arrest. [1]

COMMENT. Vomiting as an ictal phenomenon has been described by various terms including ictus emeticus, diencephalic or autonomic epilepsy, abdominal epilepsy, and cyclic vomiting as a form of epilepsy (Ped Neur Briefs June and August 1995) [2, 3]. Occipito-temporal spikes in the EEG, similar to those mentioned with PS, are described in previous reports of ictal vomiting. Are the symptoms described as PS sufficiently specific and novel to warrant classification as a separate syndrome?