Pediatric occipital lobe epilepsy: A modern review of etiological classification, management, and outcomes

Pediatric occipital lobe epilepsy (OLE) comprises syndromes with seizures originating from the posterior cerebral cortex. Previously "benign", recent International League Against Epilepsy (ILAE) updates reclassified these as self-limited or structural focal epilepsies, reflecting their complex causes and morbidity potential. The 2017 ILAE guidelines shifted from syndromic recognition to an etiology-driven approach. High-resolution magnetic resonance imaging is crucial to differentiate self-limited genetic syndromes from structural OLE (e.g., focal cortical dysplasia), as the latter often requires surgery. Self-limited epilepsy with autonomic seizures (formerly Panayiotopoulos syndrome) presents with prolonged nocturnal autonomic seizures. Childhood occipital visual epilepsy (previously Gastaut type) manifests as frequent, brief daytime visual hallucinations. Despite high seizure freedom rates with monotherapy, patients face neurocognitive challenges in visuospatial processing and academic performance. For drug-resistant structural cases, surgery offers high seizure freedom rates, though with risk of visual deficits. Accurate differentiation between idiopathic and structural OLE is essential for improving outcomes. The shift from "benign" to "self-limited" terminology emphasizes the need to monitor cognitive comorbidities and syndrome evolution. Early diagnosis is critical to avoid clinical mimics and enhance neurodevelopmental outcomes. This review examines the evolving landscape of pediatric OLE, highlighting the shift from syndromic to etiological classification and management strategies.