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Panayiotopoulos syndrome

What is a syndrome?

A syndrome is a group of signs and symptoms that, added together, suggest a particular medical condition. In epilepsy, examples of these signs and symptoms would be things like the age at which seizures begin, the type of seizures, whether the child is male or female and whether the child has physical or learning difficulties, or both. The results of an electroencephalogram (EEG) are also used to classify epilepsy syndromes. 

Epilepsy Action has more information about seizure types, learning disabilities, and the EEG.

Other names for Panayiotopoulos syndrome

  • Early-onset benign partial epilepsy with occipital paroxysms
  • Idiopathic susceptibility to early-onset benign childhood seizures with EEG occipital spikes

Panayiotopoulos syndrome

This is a relatively common type of epilepsy affecting about one in seven or one in 10 of all children with epilepsy. The most common age it begins is three to five years, but it may affect children as young as one, and as old as 15 years. Boys and girls appear to be equally affected. It does not usually run in families. However, more research needs to be undertaken in this epilepsy syndrome.

Panayiotopoulos syndrome is different to the epilepsy syndrome called ‘benign epilepsy of childhood with occipital paroxysms (BECOP)’. In BECOP, the children are usually older and the seizures consist of problems with vision and flashing lights and are usually accompanied by headaches.


The main seizure type is known as ‘autonomic’. The child may have a sudden change in behaviour and then they become pale, complain of feeling sick and will usually vomit. The pupils of the eyes often become very large (dilated) and there may be a lot of sweating and drooling (these are the ‘autonomic’ features). The child may become unresponsive and their head my turn and become fixed to one side. It may remain turned to the side for many minutes. Very often the seizure will then end with jerking movements (called clonic movements) down one, or occasionally both, sides of the body. After the seizure the child will be upset and may sleep.

Over two thirds of the seizures will occur in sleep. The sleep may be during the night or during a day-time nap. The seizures are often long-lasting, and may last 20, 30 or even 60 minutes. Even following the long seizures, once the child has woken up, they will be back to normal. The seizures are very infrequent. Many children will have just one or two seizures while others may have four or more.


The diagnosis of Panayiotopoulos syndrome is made on a detailed account of the child’s symptoms. Important features in making the diagnosis are that the episodes usually occur during sleep, and are nearly always accompanied by autonomic features, and vomiting. The child’s age is also important as most seizures occur in young children.

The EEG often shows abnormal activity (called spikes) on both sides of the brain. This is usually towards the back of the head (in the part of the brain called the [occipital lobes]). Sometimes the EEG may only show the abnormality if it is carried out when the child is sleeping. However, the EEG may also be normal in up to a quarter of children with this epilepsy syndrome. Brain scans (CT and MRI) are usually normal.

Epilepsy Action has more information on diagnosing epilepsy.


Not every child needs to be given epilepsy medicine. This is because the seizures happen infrequently and because most children will stop having seizures soon after the seizures start. An epilepsy medicine is usually prescribed if the child has had more than three or four seizures and particularly if the parents are worried. The medicines most commonly used are sodium valproate (Epilim) or carbamazepine (Tegretol). The newer epilepsy medicines may also be effective, but this is not known for sure.

Epilepsy Action has more information about treatment.


Most, if not all children with Panayiotopoulos syndrome, will show normal development in the first few years of life. Most will also have no learning or behaviour problems. Even the longer seizures do not cause any problems, and it is not thought that the seizures are dangerous. Nearly all children will stop having seizures within two or three years after the seizures first start. This is called a ‘remission’ of the epilepsy. The remission of the epilepsy happens of its own accord and is not affected by the use of epilepsy medicines. Finally, it seems to be very rare for a child with this type of epilepsy to have seizures either continuing into, or re-starting, in adult life.


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Epilepsy Action would like to thank

  • Dr Richard Appleton, and Dr Rachel Kneen, consultant paediatric neurologists at Alder Hey Children’s Hospital, Liverpool, UK and
  •  Dr Stewart Macleod, consultant paediatric neurologist at Royal Hospital for Sick Children, Glasgow, UK.
    They have kindly prepared the information on this page. It is based on their own research, experience and expertise.

This information is exempt under the terms of The Information Standard.

  • Updated June 2013
    To be reviewed June 2016

Comments: read the 5 comments or add yours


My just turned 3 son was diagnosed with P.S. at 2 years old but has been having seizures since he was 4 months old , he has also had over 40 episodes(as we call them) in this time so kind of bucks the trend with this syndrome both in age and frequency of attacks.
He always complains of violent headaches and nearly always projectile vomits when having a seizure. We administer buccal midazolam which stops the seizure very quickly but wipes him out when the drug takes effect.
I'm mainly posting this to let people know that this syndrome can effect children outside the 3-15 year old age range ussually quoted.

Submitted by Carl on

hi there my son at 3.5 yrs had a long seizures lastin longer then 30mins and it only stopped when paramedics gave him meds, b4 the seizures he woke and spewed and then went quiet and then started we was in hospital for 2 days for monitoring as we live 1.5hrs away from the hospital he then had a EEG which showed epileptic activity the lady doing the EEG could see this easily the results were sent to a pediatric nurologist and he came back with this panayiotopoulos syndrom they wanted an mri done just in case and that came back clear we then seen a regular pediatrician by this my son was about to start school and in his enrolment there was the question so i told them and they wanted the pedi to do up a action plan type thing just in case but he refused and said he doesnt have epilepy because he has only had 1 seizures so he is too old school to condisder thy syndrome now my son is 5.5yrs and has started waking up and spewing and is a bit vagiue he has also started wetting the bed and his teacher has said he has been abit vagiue at school too do u thinkin this maybe related? is it possible he is having smaller seizures and then spewing ?

Submitted by karlisle on


If you have one diagnosis from a paediatric neurologist and a different one from a general paediatrician, it would seem reasonable to pay more attention to the doctor who has more experience in the field, that is the paediatric neurologist. I wonder if the two doctors could be in touch with each other, then the regular paediatrician could maybe feel more reassured about the diagnosis.

It may be worth talking to your family doctor or the epilepsy nurse, if your son has one. They could possibly help with lines of communication between the two paediatricians. And also find a way for you to get the answers to your questions about what is happening for your son now. I’m afraid we aren’t in a position to be able to answer your questions as we’re not medically trained.

I do hope the situation becomes clearer and more straightforward for you and your son very soon.


Advice and Information Team

Submitted by Cherry on

Hi, my son started when he turned 3yo and has had four seizures since and he is now 4yo. It started one day when he had a nap, he woke up being sick and then his head turned to the right and his eyes rolled to the right. He was responding to my questions but also looked very dazed, sweating and drooling. His EEG and MRI scan came back all clear but it still plays on our mind every time he sleeps. We set up cctv in his bedroom so we can watch him at all times, he is very restless in bed all night but he has not had a seizure for 2 months now. I filmed his seizure which lasted 50 minutes, the doctors said the video gave them the best evidence to pinpoint the condition as Panayiotopoulos syndrome and are now using the video for training purposes. Heres the thing i am realising now, his temper/attitude has worsened since the seizures started and the doctors want to put him on medicine (which i am against). Does anyone else give there child medicine for this and what medicine have you been prescribed? Another thing i want to clerify is my son was carried/born breach, this wouldnt have anything to do with it would it? thanks

Submitted by James Gargan on

Hi James

Thanks for your message. It must be hard to see your son’s behaviour change since his seizures started. We often speak to parents who are worried about their child’s behaviour so you are not alone. You might find it helpful to read our information about epilepsy and behaviour problems.

It’s understandable that you want to know if there’s a cause for your son’s epilepsy. Sometimes epilepsy is caused by brain damage that happened during a difficult birth. But in around 6 out of 10 people doctors can’t find a cause for their epilepsy.

Do the doctors want to put him on epilepsy medicine or medicine to help with his behaviour? Children with panayiotopoulos syndrome don’t always need treatment with epilepsy medicine but doctors might recommend it if they have had more than three or four seizures. The medicines most commonly used are sodium valproate (Epilim) or carbamazepine (Tegretol). The newer epilepsy medicines may also be effective, but this is not known for sure. We can’t offer any advice on medicines to deal with behavior, but hopefully you will get some replies from other parents here. You could also try forum4e. It’s our online forum for people with epilepsy and their families.

It’s good to get opinions from other parents, but it’s important to remember that every child is different and medicines that suit one child may not suit another. If you have any concerns about your son taking medication it’s worth discussing your worries with his doctor.

I hope this information is useful. If you have any other questions feel free to contact the Epilepsy Action Helpline.

Epilepsy Action Advice and Information Team

Submitted by Grace, Epilepsy... on