Ideopathic childhood epilepsy, which is characterized by autonomic epiproteps with impaired consciousness and deviation of gaze, is called Panayotopulos syndrome. This deviation is characterized by a favorable outcome, it is given to treatment, but it causes considerable discomfort to the patient and his associates. Each attack can occur with varying degrees of severity, you can never predict. To obtain a positive result from therapy, it is recommended to undergo an examination, which is based on EEG.
Treatment includes the arrest of vegetative epiprots. Be sure to pay attention to preventive measures. It is not recommended to start therapy without prior consultation with a specialist, as this can lead to negative consequences.
What it is?
In a child, Panayotopulos syndrome can be diagnosed from the age of one year to fifteen years. Parents should carefully monitor the behavior of the baby, so as not to miss the disease and not provoke complications. This occipital epilepsy refers to a benign idiopathic form and was first described in 1950 by the scientist Panayotopulos, in whose honor the disease is called. He has been conducting various studies and observations for a long time, which ultimately helped to make such an important discovery.
The occipital localization is indicated by the fact that during the patient's paroxysm, the gaze is directed to the sides. However, this symptomatology is not observed in every patient. Also, during an examination on an EEG, a specialist can not always note epileptic activity in the occipital part, which can complicate the diagnosis.
Panayotopulos syndrome is accompanied by a variety of signs, and there is also a pronounced vegetative nature and because of this it is almost impossible to carry out differential diagnosis. The disease itself does not belong to common pathologies in this age group. But most often found in children from three to six years.
Kinds
In modern medicine, three types of epilepsy are distinguished, depending on the provoking factors:
- genetic
- structural;
- metabolic.
To determine exactly what violation led to the attack, the patient is advised to undergo a thorough examination. You should never engage in self-diagnosis and, especially, treatment, as this can provoke serious and irreversible consequences.
In most cases, it is not always possible to determine the form of violation. It happens that the attack is not associated with epilepsy. For the correct diagnosis, that is, the type of disease, consultation of narrow specialists such as an epileptologist, neurologist and radiologist is required. An epileptic seizure occurs due to acute damage to the brain, impaired blood flow in this organ, hemorrhage, benign and malignant neoplasms, impaired metabolic processes, and also due to prolonged and uncontrolled administration of various drugs. Therefore, before starting to use the drug, you need to consult a doctor and familiarize yourself with contraindications. Seizures are a common occurrence in patients with diabetes.
Also, experts identify pseudo-epileptic or psychogenic non-epileptic disorders, which can only be determined in a clinical setting. There are such cases when a child has two types of seizures at once.
Aura and attacks
Panayotopulos syndrome, like other types of epilepsy, is a clinical manifestation of large amounts of electrical discharges that can attract various parts of the brain. In most cases, before the onset of an attack, the patient has an aura. If everything comes from the occipital part of the brain, then the patient begins to notice colored shapes and circles in front of his eyes. If the focus is located in the depth of the temporal lobe, then in the abdomen there is an unpleasant sensation, discomfort, which gradually approaches the throat.
Attacks in patients with Panayotopulos syndrome can be either convulsive or without seizures. In this case, the patient may simply freeze in place for a while and not move, and then continue to carry out his work. And there are situations when a person just stops and begins to rub his hands. All this comes from the temporal lobe of the brain.
Patients often after a seizure note a certain pleasure. As a result, many people refuse treatment because of this. Experts also note such types of seizures as reflex photosensitive, arising from the frequent flickering of light. Therefore, children are often not allowed to watch various films or cartoons with a high content of special effects.
In a child with Panayotopulos syndrome, absences are also noted. This phenomenon is characterized by fading, accompanied by a brief blackout, with no cramps. In most cases, they are diagnosed in children from the age of four years, but can begin earlier if the patient has any other genital diseases. You can determine their nature with such examinations as a genetic test, lumbar puncture. Based on the results, treatment is prescribed that can be based on a ketogenic diet.
Panayotopulos syndrome: causes
The pioneer scientist believes that children should have a predisposition to epilepsy in the form of a benign epileptiform EEG pattern, which can only be in one out of 100 children. This disease is considered hereditary, and the patient himself is predisposed to this deviation.
Very often, experts associate the causes of Panayotopulos syndrome with a period of immaturity of the cerebral cortex, its diffuse increased excitability and excessive epileptic sensitivity of vegetative structures. But so far, precisely provoking pathogenetic mechanisms and triggers have not been established by medicine. Sometimes seizures that are confused with epilepsy can be diagnosed after received brain injuries, regardless of the age category, therefore, a neurologist and an EEG examination are required.
Symptoms of Panayotopulos syndrome in a child
A small patient can not always complain or accurately describe their condition, so parents need to carefully monitor their child with this deviation, even if he is already 10 or 15 years old. This violation, as already mentioned earlier, is accompanied by epileptic seizures that can happen at any time and place. Before starting, symptoms such as:
- bad feeling;
- an attack of nausea;
- looking away, that is, deviation of the eyes (can be short-term, constant or lasting several hours), sometimes combined with a turn of the head;
- increased arousal;
- feeling of fear;
- cephalgia;
- hyperhidrosis.
With Panayotopulos syndrome, vomiting is observed in 25% of patients, which can be single or multiple, significantly worsening overall well-being, accompanied by weakness and provoking dehydration of the body. In a child, the skin during the attack is pale, sometimes redden or cyanosis is observed. Loss of consciousness may be accompanied by myosis. Marked mydriasis is noted. There are times when the patient's pupils do not react to light.
Symptoms of Panayotopulos syndrome in a child also include tachycardia, impaired breathing, enuresis, encopresis, disorders of the gastrointestinal tract, and fever before and after the attack. Less often, the patient is diagnosed with abundant saliva, diarrhea. In most children, autonomic paroxysm is accompanied by disorders associated with consciousness. The child is lost in space and time, then fainting follows. The situation worsens gradually, along with an increase in the severity of vegetative symptoms.
Idiopathic occipital epilepsy can also have an atypical form, which is expressed in a sudden dream or falling into a stupor without convulsions, the behavior is disturbed, autonomic disorders are noted, but without vomiting and cephalgia.
An epileptic seizure in 25% of children ends in convulsions in only one half of the body. In rare cases, a child develops hallucinations, vision becomes worse, and even transient blindness can be diagnosed. Then the patient wants to sleep, and after waking up he feels quite healthy.
The epistatus in Panayotopulos syndrome is a vegetative epileptic attack, the duration of which is from half an hour to seven hours. One and the same baby can be diagnosed with various kinds of disorders at any time of the day.
How often does a child have seizures in Panayotopulos syndrome? The frequency is insignificant, for the entire period from five to ten. Between seizures, the patient's neurological status without any pronounced features. In development, the child does not lag behind his peers.
What does not apply to epilepsy? Do I need a psychiatrist consultation?
Very often, this disease is confused with other disorders. In this case, it is better to consult a specialist for qualified help and not engage in self-treatment in order to avoid negative consequences. Epilepsy should not be confused with pathologies such as:
- Sleepwalking. It does not apply to this type of disorder, but if there are other expressed symptoms, then it is worthwhile to undergo an additional examination and once again clarify the diagnosis.
- Cephalgia It does not apply to symptoms of occipital epilepsy only if the headache is not diagnosed after an attack with a swoon.
- Tiki. Externally, they differ and do not relate to this disease in any way.
- Urinary incontinence at night. Not considered an alarming sign of pathology.
In childhood occipital epilepsy, it is not always worthwhile to seek help from psychiatrists. If necessary, a neurologist can refer to this narrow-profile specialist. Consultation is also required if the child's mental function worsened during epilepsy and as a result, psychoactive drugs were prescribed.
If occipital epilepsy was diagnosed in a small patient, it is not necessary to treat it with acupuncture or other non-traditional methods, this will not give any result.
Parent Actions
If the child often twitches at night, his saliva flows, and he walks during sleep, then this is an occasion to beware and ask for help. This condition can be observed for no more than one minute, after which the little patient will not remember anything and will continue to sleep further. Some parents do not consider this an attack, but in vain, a thorough examination, an accurate diagnosis, and quality therapy are required. An alarming sign is considered and a slight twitching of the corners of the mouth, which can spread throughout the body.
Experts recommend filming nighttime episodes in a video, in order to later determine the appearance of occipital epilepsy in a child or not. It happens that the patient wakes up at night and looks at one point for a long period, then vomiting simply begins. During the day, the child is no different from his peers, he still moves and communicates. If the attack was the only one, then benign occipital epilepsy is not treated at all. In the event of a developmental delay or focal symptoms, impaired mobility, loss of skills, neuroimaging, magnetic resonance imaging, and complex genetic techniques are required.
Diagnostics
Diagnostics should be started at the first sign of an abnormality. The type of study is assigned exclusively by a specialist after a preliminary examination of the patient and a conversation with his parents. If the children have occipital epilepsy at an early age, then a 2-4 hour VEG monitoring is performed, since the baby has long periods of physiological sleep. For older patients, this type of examination is recommended only at night.
Whatever the child’s epilepsy is diagnosed, in addition to the specified technique, it is recommended to use neuroimaging, which will detect the anatomical substrate of epilepsy. Also, patients with such a serious deviation are prescribed magnetic resonance imaging of the brain, and if calcifications were detected, then an additional CT scan is performed. The survey data are serious and have a number of contraindications, which should be taken into account without fail. They do not need to be passed without prior consultation with a specialist, as this can lead to negative and irreversible consequences.
Very often, even the most experienced doctors confuse the symptoms of Panayotopulos syndrome with other diseases, such as:
- acute respiratory viral infection (ARVI);
- meningitis - an inflammatory process that occurs in the soft membranes of the brain and spinal cord, is provoked by various pathogens (bacteria, viruses);
- intestinal infection;
- acute type poisoning;
- cerebrospinal fluid crisis;
- an attack of cephalgia or migraine.
Epileptic syndrome cannot be established in a single seizure, even if there are changes in the EEG. If necessary, the child is registered with a neurologist for a certain period in order to exclude this unpleasant diagnosis. It is worth noting the fact that epileptiform activity may be present on an EEG study during clinical remission, but then disappears closer to adolescence.
Lumbar puncture is recommended for patients only if it is necessary to differentiate this syndrome with an organic type lesion, for example, a cyst, a hematoma, a neoplasm in the brain, or with neuroinfection (encephalitis, abscess). It is also necessary to take into account the fact that there will be no disturbance in the cerebral fluid.
Treatment. Preventive actions
Therapy, as mentioned earlier, will depend on the results of the examination and is prescribed exclusively by a specialist. Do not engage in self-diagnosis and, especially, the appointment of treatment, as this can lead to negative consequences, especially in this situation. If you seek qualified help in a timely manner, the result will be positive.
The treatment of epilepsy will depend on its form, the more neglected the situation, the more time and effort will be required to eliminate it. The main method of treatment for this ailment is considered to be medical, which will allow to improve the condition in many patients of different age categories. The best option is treatment with one type of drug, if this type was ineffective, then experts prescribe several antiepileptic drugs. It must be remembered that it is not recommended to take them without a doctor’s prescription. Before you start using the drug, carefully read the instructions, pay attention to contraindications and side effects.
The course depends on the general condition of the patient and the neglect of the disease. The arsenal of drugs for children with epilepsy is the same as for adults. In modern practice, there have been cases when a child cured Panayotopulos syndrome using Sultiam, which belongs to a specific group of drugs. Also, doctors can prescribe "Carbamazelin", "Oxarbazelin." If the pathology options are resistant atypical, then it is possible to use "Clobazam", "Levetiracetam", "Valproate". The duration of the course should not exceed two years.
If an attack in a child with Panayotopulos syndrome with organic brain lesions from 20 minutes to half an hour, emergency treatment is required. Vegetative status epilepticus can be stopped by the rectal or intravenous route of administration of "Phenozepam", "Clonazepam", "Diazepam".
In addition to drug therapy, a small patient may be prescribed hormonal or immunoglobulin therapy. If the treatment does not give a positive result, then it is possible to use neurosurgery. This method of treatment involves excising abnormal areas of the brain or isolating them. .
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Patients are allowed to eat foods such as red meat, chicken, fatty fish and cheese, homemade eggs, cream, butter, avocados, tomatoes, peppers, nuts, olive oil. Unsweetened fruits, dark bitter chocolate, coffee, tea are recommended in small quantities. From the diet you need to completely exclude legumes, sweet foods, potatoes, carrots, mayonnaise.
Such a diet is not always suitable for everyone, therefore, you must first consult with a nutritionist, pediatrician and neurologist.
With this syndrome, due to rare attacks and a short duration of pathology, it is recommended to carry out preventive antiepileptic measures. These include:
- proper and balanced nutrition;
- consultation with a neurologist;
- timely treatment and examination;
- frequent walks in the fresh air;
- moderate physical and mental activity;
- quality sleep;
- elimination of irritants and stressful situations.
In any situation, at the first alarming signs, you should consult a specialist. Even if you have heard that Panayotopulos syndrome in a child has been cured by micromotion, this does not mean that you need to immediately begin experimenting with your child, because each patient requires an individual approach.
Forecast
As for the prognosis, it can be different, it all depends on the nature of the disease. When epilepsy is combined with other progressive serious pathologies, the result will be disappointing, the prognosis is poor, and the therapy is useless. With this syndrome, however the situation may seem dramatic, treatment may not be necessary. This is decided only by a specialist after examination.
In modern practice, there are cases when hormones are administered to even patients of an early age category, although this is not always appropriate and has a positive result. To exclude negative consequences, you can consult with several doctors and come to a general conclusion, no one ever advises to start treatment, it is better to choose several treatment options and find the right one for your child.
Very often, small patients are diagnosed with benign syndromes that are similar but not epileptic. In this case, the child will develop normally. If the pathology is provoked by damage to the brain by a neoplasm, a stroke, an infectious disease or trauma, it is recommended to remove the structural anomaly and the attacks themselves will go away and will never disturb again.
You always need to weigh the pros and cons before starting therapy, so as not to make the child a cripple until the end of life. It must be understood that epilepsy is a disease that can be treated, even if there are structural changes in the brain. The main thing is to find the right technique. At the same time, there is a likelihood that the child may lag behind in development due to these disorders. In rare situations, you need to resort to serious actions, for example, surgery, it is better to give preference to drug therapy, a ketogenic diet.
Epilepsy and all its forms are a serious violation that causes considerable discomfort to patients and those around him, but with the right approach, you can find a way out and stabilize the situation.