There are now significant reports of ictal EEGs in 20 cases, which objectively document the seizures of Panayiotopoulos syndrome and their variable localisation at onset.[18] All these recorded seizures occurred while the children were asleep. The onset of the electrical ictal discharge was mainly occipital (7 cases) or frontal (7 cases)and consisted of rhythmic monomorphic decelerating theta or delta activity with small spikes. The ﬁrst clinical manifestation which appeared long (1–10 minutes) after the electrical onset, usually consisted of opening of the eyes as if the children were waking from sleep.