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Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 271

Clinical and electroencephalogram correlation of self-limited epilepsy with autonomic seizures

1 Department of Pediatrics, Division of Pediatric Neurology, Command Hospital, Chandimandir, Panchkula, Haryana, India
2 Child Neurology Division, Department of Pediatrics, AIIMS, New Delhi, India

Date of Submission21-Sep-2021
Date of Decision15-Nov-2021
Date of Acceptance15-Nov-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
Dr. Rahul Sinha
Department of Pediatrics, Command Hospital, Chandimandir, Panchkula, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ipcares.ipcares_287_21

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How to cite this article:
Sinha R, Singh S. Clinical and electroencephalogram correlation of self-limited epilepsy with autonomic seizures. Indian Pediatr Case Rep 2021;1:271

How to cite this URL:
Sinha R, Singh S. Clinical and electroencephalogram correlation of self-limited epilepsy with autonomic seizures. Indian Pediatr Case Rep [serial online] 2021 [cited 2022 Jan 20];1:271. Available from: http://www.ipcares.org/text.asp?2021/1/4/271/331377

A 2-year-old, developmentally normal, boy presented with multiple seizure-like events over 10 days. These episodes were described as brief (20–30 s), vacant stares, associated with impaired awareness, hypersalivation, retching, vomiting, tongue thrusts, and pallor of the face and body. A few episodes exhibited tonic posturing of the upper limbs [[Figure 1] and Video 1][Additional file 1]. Other aspects of history were normal. There was no dysmorphism or neurocutaneous markers. Neurological examination was normal. Cranial Magnetic Resonance Imaging (epilepsy protocol) was normal. The drug-induced sleep electroencephalogram (EEG) revealed multifocal epilepsy with bilateral occipital predominance [Figure 2]. A diagnosis of Self-Limited Epilepsy with Autonomic Seizures (SeLEAS) or “Panayiotopoulos syndrome” was made, based on semiology and EEG findings. Seizures stopped within 72 h of starting sodium valproate.
Figure 1: The seizure semiology was a vacant stare with impaired awareness associated with hypersalivation, retching, vomiting and tongue thrusting, and pallor of the face and body, lasting for 20–30 s. There was no postictal drowsiness

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Figure 2: The interictal sleep electroencephalogram record shows frequent sharp wave, spike and slow wave (1–3 Hz, 300–500 microvolt) discharges arising from O1 and O2 with spread to adjacent electrodes, accentuated during photic stimulation. There are independent frequent sharp wave discharges from F3, F4, P3, and FP3 suggestive of multifocal epilepsy with bilateral occipital predominance

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SeLEAS is a relatively frequent, benign epileptic syndrome characterized by predominant autonomic symptoms and/or focal onset motor seizures. The former include retching, emesis, changes in color (pallor, flushing, or cyanosis), pupillary dilatation, hypersalivation, cardiorespiratory, and thermoregulatory alterations.[1] Clinicians should be aware of this entity as these events are frequently misdiagnosed as acute encephalitis, syncope, migraine, cyclic vomiting syndrome, motion sickness, sleep disorder, or gastroenteritis.[2] Interictal EEG shows occipital spikes. Multifocal spikes with high amplitude sharp-slow wave complexes can also occur at various locations.

Seizures will stop in most children within 2–3 years of the first episode. The risk of developing epilepsy in adulthood is similar to the general population. Anticonvulsant therapy (oxcarbamazepine, valproate, and levetiracetam) are indicated when seizure frequency is high.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given her consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Specchio N, Trivisano M, Di Ciommo V, et al. Panayiotopoulos syndrome: A clinical, EEG, and neuropsychological study of 93 consecutive patients. Epilepsia 2010;51:2098-107.  Back to cited text no. 1
Parisi P, Villa MP, Pelliccia A, et al. Panayiotopoulos syndrome: Diagnosis and management. Neurol Sci 2007;28:72-9.  Back to cited text no. 2


  [Figure 1], [Figure 2]


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