Panayiotopoulos Syndrome - A Bizarre Form of Epilepsy

If you're not familiar with medical terms, epilepsy might not sound too familiar. Seizure is a term you are more likely to have heard of at some point or another. While these are two different terms when we define them medically, for simplicity we can assume them to be the same thing. What picture comes to your mind when you hear the term seizure? A person lying on the floor, shaking uncontrollably, foaming in the mouth. Right?

I have a very interesting story to share with you then!

I was doing my psychiatry rotation and was seeing patients with the Head of Psychiatry. An young female patient with her parents came in with complains of nausea and occasionally vomiting. Yes, I was equally confused as to why this patient is in the psych department.

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What we discovered after an elaborate history taking is, these symptoms have been occurring for years and they have consulted numerous Medicine specialists and nada, she still complains the same.

Now her parents are convinced she's faking it all to either gain attention or skip studies, school, etc. Hence the need for psychiatric consultation. So my professor did what anyone would do. Prescribe some anti-psychotic drugs Give her an Electroencephalogram! Like....whaaaat!

I murmured to myself, ইতা নিজে ফল হই গিয়ে নি কনো? Meaning did my Psych professor himself turn mad. I mean, word was already out on the streets....

After the patient left, i asked him what was that about sir? He simply smiled and said we'll find out tomorrow.

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So while we wait for the patient to return, let me tell you a little bit about seizures and epilepsy.

What basically happens is for whatever reason (too complicated to discuss in this post), the electrical activity in the brain gets disrupted and the balance between excitatory and inhibitory impulses are tilted. This results in moments of uncontrolled neuronal transmission resulting in impulses being sent to different parts of the body and the body simply responds to the impulses.

So, if too much activity is happening in the part of the homonculus adjacent to the arms, the arms start to have jerky movements for example. These abnormal brain activities can be easily picked up on and EEG (electroencephalogram).

Depending on the position of the electrical activity, the possibilities are endless. Because the motor cortex (the part of the brain dealing with movements) is so large, most seizures involve some form of abnormal movement and that's why people usually associate seizures with jerky/shaking movements.

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The next day the patient returns with her EEG reports and lo and behold : EEG shows abnormal patterns consistent with epilepsy!

And then the professor explains me, the symptoms of epilepsy doesn't always have to be a movement manifestation. This patient's abnormal activity was happening in a region of the brain which deals with the gastrointestinal functions, hence the manifestation with gastrointestinal symptoms such as nausea and vomiting. Might have been abdominal pain, diarrhea!

This is an extremely rare condition called Panayiotopoulos syndrome. So much so, that this doesn't even make it to most of the internal medicine textbooks! Or maybe it's a very under-diagnosed disease because not many people are thinking about it in their differential diagnoses of nausea and vomiting! Who knows!