EEG of a 4-year-old boy with autonomic status epilepticus recorded from onset to termination.

Top: High amplitude spikes and slow waves are recorded from the bifrontal regions prior to the onset of the electrical discharge, which is also purely bifrontal (arrow).

Bottom: First clinical symptoms with three or four coughs and marked tachycardia appeared 13 min after the onset of the electrical discharge, when this had become bilaterally diffuse. Subsequent clinical symptoms were tachycardia, ictus emeticus (without vomiting) and impairment of consciousness. No other ictal manifestations occurred until termination of the seizure with diazepines 70 min after onset.

Another lengthy autonomic seizure was recorded on video EEG 1 year later. The onset of symptoms was different with mainly tachycardia and agitation.

From Panayiotopoulos (2004)⁹⁰ with the permission of the Editor ofEpilepsy and Behaviour. Figure courtesy of Dr Michael Koutroumanidis, MD from the Department of Clinical Neurophysiology and Epilepsies, Guy’s & St. Thomas’ NHS Trust, UK.