Nocturnal (evolving to nonconvulsive status epilepticus) and diurnal autonomic episodes in Panayiotopoulos syndrome

A 5.5-year-old female had her first episode during sleep when she vomited three times and then appeared to have gone to sleep again. Two hours later, the mother tried to wake the child, but she was nonresponsive; her eyes were turned fixed to the right, and her face was expressionless and pale. She recovered completely about half an hour later on the way to the hospital. One month later she started having many daily episodes of tachycardia, flushed face, mydriasis, a vague wondering expression, and retrosternal discomfort lasting less than a minute. This video-EEG shows high amplitude theta waves, prominent in the left frontotemporo-occipital, that became generalized after about 10 seconds and were associated clinically with slow wondering horizontal head movements, vague look, mydriasis, and flushed face. The episode lasted 1 minute. (Contributed by Dr A. Covanis.)