1496 When Suspect Panayiotopoulos Syndrome (PS) In a Child with Clinical Diagnosis of Gastric Esophagus Reflux Disease (Gerd)

Panayiotopoulos syndrome is “a benign age related focal seizure disorder occurring in early and mid-childhood. It is characterized by seizures, often prolonged, with predominantly autonomic symptoms, and by an EEG that shows shifting and/or multiple foci, often with occipital predominance” (definition of International League Against Epilepsy). In literature the clinical features of PS was frequently mistaken as non-epileptic conditions such as acute encephalitis, syncope, migraine, cyclic vomiting syndrome, motion sickness, sleep disorder, or gastroenteritis. In our experience during the last 2 years we have observed 4 children misdiagnosed by clinical history for GERD. Until now PS is underestimated with the consequences of high morbidity and costly mismanagement. These 4 children were referred to general pediatrician at the age of 2–3 years because they started suffering from gastrointestinal emetic symptoms: nausea, retching, and vomiting. The attacks occurred mainly during sleep without sensory-motor clinical signs of seizure. One child also had monthly episodes of severe headache with clinical characteristics of migraine without aura. After a treatment with proton pump inhibitors (PPI) and anti-acid without benefits, according to the literature, they were sent to neurologist for suspection of PS which was confirmed by EEGs occipital features. Because of the importance of the symptomatology, the children have been treated with Lamotrigine with benefit. Conclusions When a child presents symptoms suggestive of GERD but non responding to specific GERD therapy, there is indication to effect an EEG to investigate a PS.