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Clinical findings in children with occipital paroxysmal discharges
A Fois1, F Malandrini, D Tomaccini
1Institute of Pediatrics, University of Siena, Italy.
Insights
Occipital paroxysmal discharges (OPDs) in children are linked to various neurological and behavioral issues. Most children experience symptom resolution with age, suggesting a non-lesional origin for OPDs.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Occipital paroxysmal discharges (OPDs) are associated with diverse clinical manifestations in children.
- Understanding the spectrum of symptoms and long-term outcomes is crucial for managing these cases.
Purpose of the Study:
- To investigate the clinical symptoms and patient outcomes in a cohort of children diagnosed with OPDs.
- To determine factors influencing normalization and the origin of OPDs.
Main Methods:
- Retrospective study of 293 children with OPDs.
- Clinical evaluation and electroencephalogram (EEG) monitoring.
- Follow-up data available for 141 children, with extended follow-up (≥9 years) in some cases.
Main Results:
- Commonly associated symptoms included mental retardation, neurological deficits, behavioral problems, ocular symptoms, and various seizure types.
- Eight patients were diagnosed with benign epilepsy with occipital spike and wave (BEOSW).
- Clinical normalization was observed in 17 children and normalization of both clinical symptoms and EEG in 25 children with at least 6 months follow-up. Long-term follow-up (≥9 years) showed complete clinical normalization in all cases.
- Antiepileptic drug use did not significantly impact outcomes, despite achieving seizure control in 26 patients.
Conclusions:
- OPDs present with heterogeneous, often non-ictal, clinical symptoms in children.
- The age-dependent disappearance of OPDs suggests a non-lesional etiology.
- Long-term follow-up indicates a favorable prognosis with eventual clinical normalization.
Abstract:
Occipital paroxysmal discharges (OPDs) have been related to a variety of clinical problems. To evaluate associated symptoms and patient outcome, we studied 293 children with OPDs. Follow-up of more than 6 months was available in 141 children. Mental retardation, neurological symptoms, behavior problems, ocular symptoms, and convulsions of various types were present. Eight patients had ictal visual phenomena consistent with the diagnosis of benign epilepsy with occipital spike and wave (BEOSW). In the 141 children with at least 6 months follow-up, 58 had other types of convulsions. Clinical and EEG normalization was observed in 25 and clinical normalization only in 17. The use of antiepileptic drugs did not seem to influence the outcome although seizure control was obtained in 26 patients. In all the cases where follow-up was 9 or more years, clinical normalization was observed. Clinical symptoms in these patients were quite heterogeneous and frequently not ictal. The disappearance of OPDs with increasing age points to their being "not lesional" in origin.