Colin Ferrie and Richard Grünewald, in their March 17
commentary,1 highlight a common and benign childhood epileptic
syndrome and emphasise the predominant autonomic manifestations,
which have immense clinical implications. These autonomic
seizures and autonomic status epilepticus are peculiar to
childhood.1—3 They do not occur in adults; ictus emeticus (not
in the same sequence as in children) is exceptional (18 cases
only) in large neurosurgical series.3 In children, autonomic
seizures and autonomic status epilepticus, are common, occurring
in 6—7% of childhood epilepsy.1—3 They largely affect otherwise
healthy children, but 10—20% might be the result of documented
brain pathology.1—3 Irrespective of cause, emetic processes
(nausea and vomiting) predominate; 70% have ictus emeticus.1—3
Others include pallor, sometimes flushing or cyanosis,
mydriasis, and, less often, miosis, cardiorespiratory changes,
incontinence of urine and faeces, thermoregulatory alterations,
and modifications of intestinal motility.1