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Paroxysmal visual disturbances of epileptic origin and occipital epilepsy in children
Insights
A rare form of epilepsy mimicking migraine in children was investigated. One case of benign occipital epilepsy was identified, suggesting this distinct epileptic syndrome warrants further definition.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurophysiology
Background:
- The existence of a specific partial occipital epilepsy syndrome, clinically similar to migraine and potentially linked to childhood benign focal epilepsies, remains debated.
- Investigating children with epilepsy and visual complaints, or those with migraine, can help clarify this debated epileptic syndrome.
Observation:
- The study analyzed 195 children with idiopathic epilepsy, focusing on twelve with visual seizure complaints and four with associated migraine.
- Electroencephalographic (EEG) data from thirty children diagnosed with migraine accompagnée were also examined, revealing paroxysmal spike-waves in 10%.
Findings:
- One child presented with features consistent with Gastaut's 1982 description of benign partial occipital epilepsy, including phosphenes, visual aura, headaches, and specific EEG abnormalities.
- Other epileptic children, including those with co-occurring migraine, exhibited different epilepsy types.
- The identified case suggests this distinct epileptic syndrome can be differentiated from symptomatically similar conditions.
Implications:
- The findings support the potential existence of a distinct benign partial occipital epilepsy syndrome in children.
- Further research is needed to definitively establish the characteristics and nosological position of this epilepsy subtype.
- Differentiating this syndrome from migraine and other epilepsies is crucial for accurate diagnosis and management.
Abstract:
A special form of partial occipital epilepsy clinically resembling migraine and possibly related to the benign focal epilepsies of childhood has recently attracted attention (Gastaut 1982) but its existence is still debated. To approach this problem, in a group of 195 children with idiopathic partial or generalized epilepsy we have studied those who had visual complaints as part of their seizures (twelve children) and those who also had migraine (four children). The clinical and electroencephalographic features of these children were analyzed together with those of another group of thirty children diagnosed as migraine accompagnée in which an EEG had been obtained (3/30, i.e. 10% had paroxysmal spike-waves: one centrotemporal focus, two generalized spike-waves). One child with the type of epilepsy described by Gastaut (1982) as partial benign occipital epilepsy (phosphenes, moving lights, headaches and occipital high voltage biphasic spike-waves blocked by eye opening on the EEG) was found in the epileptic group whereas the other children of this group, including those with associated migraine, had other types of epilepsy. This "new" type of epileptic syndrome can be distinguished from symptomatically resembling entities but its place needs to be further defined.