Covanis Athanasios, Lada Christina, Skiadas Konstantinos
Neurology Department, Agia Sophia Children's Hospital, 11527 Goudi-Athens, Greece.
Epileptic Disord. 2003 Sep;5(3):139-43.
Centrotemporal spikes are the EEG marker of Rolandic epilepsy, while ictus emeticus is one of the main seizure manifestations of Panayiotopoulos syndrome. Ictus emeticus has not been reported in Rolandic epilepsy. Out of a population of 1340 children with focal afebrile seizures we studied 24 children who had emetic manifestations in at least one seizure and centrotemporal spikes in at least one EEG. They were of normal neurological status and had a follow-up of at least two years after the last seizure. All children had sleep EEG following sleep deprivation. Two groups of patients were identified. Group A (12 patients) with EEG centrotemporal spikes only and group B (12 patients) with centrotemporal spikes and spikes in other locations. In 21 patients, ictal emetic manifestations culminated in vomiting and in three only nausea or retching occurred. The commonest presentation was ictus emeticus at onset followed by deviation of the eyes or staring, loss of contact and floppiness. In 79%, seizures occurred during sleep. Autonomic status epilepticus occurred in 37.5%. The mean age at onset was 5.3 years. Overall analysis of the clinical and EEG data points out that the vast majority of these patients primarily suffer from Panayiotopoulos syndrome. Twenty patients (83%) had ictal semiology typical of Panayiotopoulos syndrome, but five also had concurrent Rolandic symptoms and four later developed pure Rolandic seizures. The other four patients (17%) had typical Rolandic seizures with concurrent ictus emeticus. These findings suggest a link between Rolandic epilepsy and Panayiotopoulos syndrome, the two most important phenotypes of the benign childhood seizure susceptibility syndrome.
中央颞区棘波是罗兰多癫痫的脑电图标志物，而呕吐性发作是潘纳约托普洛斯综合征的主要发作表现之一。罗兰多癫痫尚未有呕吐性发作的报道。在1340例局灶性无热惊厥儿童中，我们研究了24例至少有一次发作时有呕吐表现且至少一次脑电图有中央颞区棘波的儿童。他们神经状态正常，自最后一次发作后至少随访了两年。所有儿童在睡眠剥夺后进行了睡眠脑电图检查。确定了两组患者。A组（12例患者）仅有脑电图中央颞区棘波，B组（12例患者）有中央颞区棘波及其他部位棘波。21例患者发作时的呕吐表现以呕吐告终，3例仅出现恶心或干呕。最常见的表现是发作开始时出现呕吐性发作，随后是眼球偏斜或凝视、失去联系和肢体松软。79%的发作发生在睡眠期间。自主性癫痫持续状态发生率为37.5%。发病的平均年龄为5.3岁。对临床和脑电图数据的总体分析指出，这些患者中的绝大多数主要患有潘纳约托普洛斯综合征。20例患者（83%）有潘纳约托普洛斯综合征典型的发作症状学，但5例同时有罗兰多症状，4例后来发展为单纯的罗兰多癫痫发作。另外4例患者（17%）有典型的罗兰多癫痫发作并伴有呕吐性发作。这些发现提示了罗兰多癫痫和潘纳约托普洛斯综合征之间的联系，这是良性儿童癫痫易感性综合征的两个最重要的表型。
