Case Study: Neuropsychological and Electroencephalogram Findings in Suspected Panayiotopoulos Syndrome

Abstract

Panayiotopoulos syndrome (PS) is a common form of childhood epilepsy characterized primarily by autonomic seizures, which often last upwards of 20–30 min, thus meeting the criteria for Autonomic Status Epilepticus (ASE). While prognosis for PS is typically positive, subtle neuropsychological deficits have been reported, with one study demonstrating more marked changes following episodes of status epilepticus (SE). Despite the growing body of evidence supporting impairment in areas such as language, attention, and executive functions before seizures resolve, research suggests that these patients are rarely referred for neuropsychological evaluation. As a result, neuropsychologists may not be familiar with PS despite its frequency, and patients demonstrating these subtle deficits may not be receiving supports which allow them to fully engage in academic and extracurricular activities and maximize overall quality of life. Additionally, these patients often show internalizing symptoms which may also affect quality of life and academic performance if not addressed. This case study provides a brief overview of the existing literature on PS as well as an example of a school-age patient presenting with a neuropsychological profile and electroencephalogram (EEG) findings largely consistent with the existing literature. A brief discussion of interpreting inconsistent performance in the context of established attention difficulties and language delays — including failure of multiple embedded performance validity tests — is also included.

Appendix

Tables 1–9: Test results and corresponding citations for performance on neuropsychological testing.

INTELLIGENCE

Wechsler Intelligence Scale for Children – 5.^th Edition (WISC-V; Wechsler, 2014)

Index/Subtest	Standard Score	Scaled Score	Percentile
FSIQ	95		37
Verbal Comprehension	92		30
Similarities		6	9
Vocabulary		11	63
Visual Spatial	111		77
Block Design		11	63
Visual Puzzles		13	84
Fluid Reasoning	100		50
Matrix Reasoning		7	16
Figure Weights		13	84
Working Memory	79		8
Digit Span		5	5
Picture Span		8	25
Processing Speed	105		63
Coding		12	75
Symbol Search		10	50

LANGUAGE

Boston Naming Test – Second Edition (BNT; Kaplan et al., 2001)

Z-score	Percentile
-1.96	~ 2.5

MOTOR/VISUAL

Grooved Pegboard (Norms from Skogan et al., 2018).

Hand	Z-score	Percentile
Dominant (Right) Hand	− 1.28	~ 10
Non-Dominant Hand	− 0.61	~ 27

Beery-VMI (Beery & Beery, 2010)

Subtest	Standard Score	Percentile
Visual Motor Integration	96	39
Visual Perception	97	42
Motor Coordination	105	63

ATTENTION

Conners Kiddie Continuous Performance Test-Second Edition

(K-CPT 2; Conners, 2015)

Scale	T-Score	Description
Detectability	48	Average
Omissions	46	Average
Commissions	48	Average
Perseverations	46	Average
Hit Reaction Time (HRT)	61	Slow
HRT Standard Deviation	49	Average
Variability	51	Average
Hit Reaction Time Block Change	56	Average
Hit Reaction ISI Change	44	Average

MEMORY

Child and Adolescent Memory Profile (ChAMP; Sherman & Brooks, 2015)

Index	Standard Score	Percentile
Screening Index	74	4
Domain/Subtest	Scaled Score
Verbal Memory
Lists Immediate	9	37
Lists Delayed	7	16
Lists Recognition	1	< 1
Visual Memory
Objects Immediate	2	< 1
Objects Delayed	10	50

ACADEMIC

Bracken Basic Concept Scale-3.^rd Edition (BBCS-III; Bracken, 2006a, 2006b)

School Readiness Composite	Scaled Score	Percentile Rank
Expressive	82	12
Receptive	85	16

ADAPTIVE/BEHAVIORAL

Behavior Assessment System for Children – Third Edition Parent Rating Scales (BASC-3 PRS-C; Reynolds & Kamphaus, 2015)

Scale	T-Score
Hyperactivity	47
Aggression	42
Conduct Problems	45
Anxiety	46
Depression	45
Somatization	61*
Attention Problems	56
Atypicality	54
Withdrawal	51
Externalizing Problems	44
Internalizing Problems	51
Behavioral Symptom Index	49
Adaptability	43
Social Skills	52
Leadership	42
Functional Communication	37*
Activities of Daily Living	44
Adaptive Skills	43

1. *Scores of 40–31 on measures of adaptive skills suggest at-risk symptoms
2. *Scores of 60–69 on clinical scales suggest at-risk symptoms

Conners 3 – Parent form (Conners, 2008)

Conners 3 Content Scales	T-Score
Inattention	66*
Hyperactivity/Impulsivity	65*
Learning Problems	82**
Executive Functioning	59
Defiance/Aggression	42
Peer Relations	43
DSM-5 Symptom Scales	T-Score
ADHD Predominantly Inattentive Type	68*
ADHD Predominantly Hyperactive/Impulsive Type	61
Conduct Disorder	45
Oppositional-Defiant Disorder	43
Conners 3 Index Scores	T-Score
Conners 3 Global Index: Restless-Impulsive	60
Conners 3 Global Index: Emotional Lability	45
Conners 3 Global Index: Total Score	54

1. *T-scores of 65–69 suggest elevated symptoms
2. **T-scores of 70 or higher suggest very elevated symptoms