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[Idiopathic childhood occipital epilepsy]
S Ballesteros García1, B Otero Martínez, L Lagunilla Herrero
1Servicio de Pediatría, Hospital de Cabueñes, Gijón.
Insights
Childhood occipital epilepsy (COE) presents with distinct clinical and EEG features. Type II COE often manifests as status epilepticus, requiring careful diagnosis, while Type I COE may lead to learning difficulties.
Area of Science:
- Epilepsy Research
- Pediatric Neurology
- Clinical Electrophysiology
Context:
- Idiopathic childhood occipital epilepsy (COE) encompasses distinct subtypes with varying clinical presentations.
- Understanding these subtypes is crucial for accurate diagnosis and management in pediatric epilepsy.
Purpose:
- To detail the clinical and electroencephalographic (EEG) characteristics of children diagnosed with idiopathic COE.
- To evaluate the long-term outcomes for patients with COE.
Summary:
- This study reviewed 10 children with COE (2 Type I, 6 Type II, 2 intermediate). Type I COE featured daytime visual and motor seizures, while Type II COE presented with nocturnal seizures, often as status epilepticus. Neuroimaging was normal; EEG showed occipital slow wave spikes.
- Type II COE can mimic other neurological emergencies and migraine with aura. Type I COE, though often considered benign, may be associated with learning problems.
Impact:
- Clinical and EEG findings align with existing literature on childhood occipital epilepsy.
- Highlights the diagnostic utility of ictal EEG and the potential for misdiagnosis of Type II COE.
- Emphasizes that Type I COE may have long-term consequences beyond childhood seizures.
Objective:
To describe the clinical and electroencephalographic (EEG) features, as well as the outcome of children diagnosed with idiopathic childhood occipital epilepsy (COE) in our hospital.
Methods:
A retrospective review of the clinical records of children diagnosed with COE in the previous 10years was carried out with description of clinical and EEG features and neuroimaging studies. The outcome of patients followed-up for at least 5 years was also reviewed.
Results:
Ten children were studied: two with type I (Gastaut) COE, six with type II (Panayiotopoulos) COE, and two with intermediate forms of the disorder. Patients with type I COE suffered daytime seizures with visual symptoms (hallucinations and amaurosis) followed by versive motor partial complex seizures with secondary generalized seizures. Age of onset was late childhood and the seizures reappeared in adolescence when therapy was discontinued. Patients with type II COE had nocturnal seizures consisting of tonic deviation of the head and eyes, some degree of disturbance of consciousness and hypotony followed by vomiting and hemiclonic movements or generalized tonic-clonic seizures. In five children, the first presenting symptom was status epilepticus. In all patients the age of onset was between 1 and 4 years. The results of neuroimaging studies were normal. EEG records showed normal baseline activity with slow wave spikes in the occipital region that disappeared or were reduced by eye opening.
Conclusions:
Our clinical and EEG findings are similar to those of other published studies. Type II COE frequently presents as status epilepticus and can be confused with other neurologic emergencies. Ictal EEG is useful to clarify the diagnosis. In type II COE, ictal symptomatology may overlap with migraine with aura. Although designated benign, patients with type I COE may develop learning problems and continue to have seizures throughout childhood.