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Panayiotopoulos syndrome, a common and benign childhood epileptic syndrome
  1. Mark Manford

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    Edited by C P Panayiotopoulos (Pp 158, 345.00). Published by John Libbey, Eastleigh, 2002. ISBN 0 86196 619 8

    Dr Panayiotopoulos has written this monograph cum swan song about the syndrome that he has put on the diagnostic map and to which his name has been attached. This childhood syndrome certainly breaks many “epilepsy rules”. The seizures usually start with autonomic symptoms nausea, retching, or vomiting and evolve to altered awareness usually only after several minutes. Tonic deviation of the eyes follows, lasting many minutes, which may evolve into hemiclonic or tonic clonic seizures. Sometimes children suffer atonic seizures “ictal syncope”, another atypical form. About half of patients have seizures, which last more than half an hour—technically status epilepticus—and yet prognosis is good, and one third of affected children only ever experience one episode, the median number is three. The EEG often shows occipital spikes but the spikes may also be elsewhere and in one third are multifocal, usually a poor prognostic sign in epilepsy but not in this benign syndrome. There is often fixation-off sensitivity: electrographic paroxysms which appear when the child is in complete darkness or in light but is not visually fixating. They are abolished by fixation, irrespective of ambient illumination.

    He argues the case for a benign focal seizure susceptibility syndrome, including this condition and benign epilepsy with centrotemporal spikes as different expressions of a related underlying tendency.

    In his book Dr Panayiotopoulos describes his syndrome in detail including all the clinical and electrographic variants, with numerous case histories. His clinical experience is manifest in the text, which presents his personal views. The main criticisms of the book are the quality of the publishing, with variable print quality and illustrations and that it requires substantial padding to turn this relatively narrow topic into a whole book. However, it will be a reference source for anyone wishing to appreciate the subtleties of this syndrome.

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