A case of Panayiotopoulos syndrome showing an atypical course Makiko Saitoh, Masaya Kubota, Ikumi Kimura, Masashi Mizuguchi, Takashi Igarashi  Seizure - European Journal of Epilepsy  Volume 15, Issue 8, Pages 643-648 (December 2006) DOI: 10.1016/j.seizure.2006.08.010 Copyright © 2006 British Epilepsy Association Terms and Conditions

Figure 1 (a) Interictal EEG at the age of 4 years and 1 month, 6 months after the onset of typical autonomic seizures. Right occipital spike–waves were followed by generalized discharges of sharp and slow waves. (b) Ictal EEG at the age of 8 years. While awoke but with her eyes closed, the patient suddenly opened her eyes and became unresponsive. During the initial 2s of the seizure, EEG showed a bilateral frontal occipital polyspike–wave burst. A subsequent generalized spike–wave burst continued for 5s (between the two solid triangles), during which the patient remained unresponsive. Seizure - European Journal of Epilepsy 2006 15, 643-648DOI: (10.1016/j.seizure.2006.08.010) Copyright © 2006 British Epilepsy Association Terms and Conditions

Figure 2 Serial interictal EEGs. (a) Sleep recording obtained at 5 years of age reveals a right-side temporal-occipital spike. (b) Spike foci became bilateral and had spread to the central and parietal regions by 7 years of age. (c) Spike foci were located bilaterally in the frontotemporal regions at 8 years of age. The patient had frequent seizures with oculochephalic deviation followed by brief impairment of consciousness. Seizure - European Journal of Epilepsy 2006 15, 643-648DOI: (10.1016/j.seizure.2006.08.010) Copyright © 2006 British Epilepsy Association Terms and Conditions

Figure 3 MEG at the age of 10 years. An EEG was recorded simultaneously. Bilateral frontal paroxysms (frame A) preceded generalized discharges (frame C). The current source of the frontal paroxysms appeared to be localized in the anterior frontal area on the MEG study (B). However, this dipole was not stable (GOF=0.65–0.70). The current sources of the generalized spike and wave discharges were localized in the bilateral the temporal cortices (D). These dipoles were stable and reproducible, with GOF exceeding 0.90. Seizure - European Journal of Epilepsy 2006 15, 643-648DOI: (10.1016/j.seizure.2006.08.010) Copyright © 2006 British Epilepsy Association Terms and Conditions

Figure 4 Whole head MEG at the appearance of a generalized spike and wave burst on simultaneous EEG (shown in Fig. 3, frame C). Seizure - European Journal of Epilepsy 2006 15, 643-648DOI: (10.1016/j.seizure.2006.08.010) Copyright © 2006 British Epilepsy Association Terms and Conditions