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Panayiotopoulos syndrome: a common and benign childhood epileptic syndrome

2002; Elsevier BV; Volume: 202; Issue: 1-2 Linguagem: Inglês

10.1016/s0022-510x(02)00224-1

1878-5883

Spencer G. Weig,

Epilepsy research and treatment

The nosology of epilepsy is clearly a ‘work in progress’. Nowhere is this more obvious to clinicians and the researchers than in the idiopathic localization-related epilepsies of childhood. Indeed, the very term ‘epilepsy’ becomes problematic when many children with the electroencephalographic signature of these disorders will have no actual seizures during childhood. The author has written a small book (hard cover, 174 pages, 34×28×1.2 cm [10×7×1/2 in.]) that delves in great detail into one subgroup of these disorders: the occipital syndromes. He is eminently qualified, since, as the title implies, one of the occipital syndromes bears his name. The first two thirds of the book contain his argument while the final third consists of a lengthy appendix with 60 case histories. The thesis is that under the general rubric of ‘childhood seizure susceptibility syndromes’, there are multiple disorders that are age-related in both clinical and electroencephalographic expression: febrile convulsions in children under 3, Rolandic seizures in children 7–13, and Panayiotopoulos syndrome in the 3- to 6-year-old child. The semiology is of an otherwise normal preschool child with rare partial seizures, often at onset of sleep, that are: (1) autonomic in character, with prominent nausea and vomiting at onset (so-called ictus emeticus); (2) associated with forced lateral eye deviation; and (3) often prolonged to the point of status epilepticus. The EEG may show occipital spikes that are often dramatically activated by eye closure or sleep, leading to what he feels is the misclassification of the disorder as one of the occipital syndromes. Frequently though, the EEG may have multifocal, far more anterior spikes, as well as generalized spike-wave discharges. With or without treatment, the seizures abate within several years. While the author's presentation is compelling and rings true to the ear of this observer, the book has several drawbacks. At times, the line between argument and apologia becomes blurred, giving the work a defensive tone. In addition, it is repetitive and poorly edited. The author specifically targets the book to a general pediatric audience, which does not seem appropriate given the sophisticated knowledge base in epilepsy and electroencephalography that this book presupposes. Nevertheless, for epileptologists and electroencephalographers, this reasonably priced book provides much useful information and documentation. It should be required reading for all those involved in the ongoing controversies surrounding the (re)classification of the epilepsies.