Clinical Differentiation of Self-Limited Epilepsy With Autonomic Seizures (Panayiotopoulos Syndrome) and Childhood Migraine

BACKGROUND AND OBJECTIVES: Migraine is the most common single cause of health loss among children and adolescents. A specific type of pediatric benign focal epilepsy, i.e., self-limited epilepsy with autonomic seizures (SeLEAS), formerly called Panayiotopoulos syndrome, is often accompanied by ictal or postictal headache, which can sometimes be indistinguishable from migraine. To date, no studies have provided estimates of the proportion of misdiagnoses in this context. This study aimed to assess the proportion of pediatric patients labeled as having "migraine" or "headache" who actually have SeLEAS. METHODS: A retrospective review was conducted of EEG findings and physicians' letters from 186 patients aged 3 to 14 years, referred over a 2-year period to a tertiary care university hospital's pediatric neurology department for "migraine" or "headache." RESULTS: Based on clinical history, EEG results, and the clear efficacy of antiseizure medication (ASM), 6.5% (n = 12) of the children were ultimately diagnosed with SeLEAS. An additional 3 patients showed no improvement with pharmacotherapy using only 1 antiseizure substance. Furthermore, 12.4% (n = 23) of children and adolescents presenting with headache attacks met the clinical and EEG criteria for SeLEAS but did not receive ASM. Reasons included that the diagnosis was not recognized during consultation (n = 16) or that medication was either not recommended by the physician or not initiated by the family (n = 4). In total, 18.8% (n = 35) of pediatric patients initially diagnosed with "migraine" or "headache" received a possible, probable, or definite diagnosis of benign focal epilepsy with autonomic seizures. DISCUSSION: When evaluating children and adolescents with headache, clinicians should give greater consideration to SeLEAS as a differential diagnosis than in the past, especially due to its significant therapeutic implications.