Difficoltà di inquadramento sindromico di una epilessia focale non sintomatica con punte-onda occipitali

Syndromic classification is important in patients with epilepsy to evaluate the prognosis as soon as possible, but unfortunately a classification may be difficult even after a relatively long follow-up period. We describe the case of a young boy who presents a non-symptomatic focal epilepsy with occipital spikes and waves. Epilepsy onset took place at 3 years of age characterized by different seizures types. During evolution (4 years) complex motor seizures with autonomic features persisted resistant to AED. Clinical picture has some features currently described in Panayiotopoulos syndrome, an idiopathic childhood focal epilepsy, but other features (semiology frequency and length of seizures, partial response to treatment) do not support this hypothesis. The description of “borderline” patients, according to typical classified epileptic syndromes, can be useful for prognostic and treatment suggestions.