[Benign spike-wave occipital epilepsy in children]

Among the partial epilepsies of childhood with a mainly if not exclusively functional focus, a place must be given, next to epilepsy with rolandic spikes, to 'benign epilepsy with occipital spike-waves' featuring: (1) from the EEG standpoint: (a) normal background activity; (b) interictal high amplitude S.W. occurring only when the eyes are closed and recurring more or less rhythmically in the occipito-posterotemporal region of one or both hemispheres (in the last case synchronously or asynchronously, symmetrically or asymmetrically); (c) ictal localized self-maintaining discharges over one occipital lobe, even when the interictal S.W. are bilateral; (2) from the clinical standpoint: (a) between seizures: normal neuropsychiatric, neuroradiological, CT and ophthalmological status; (b) during seizures: visual symptoms (amaurosis, phosphenes, complex hallucinations or illusions) which are: (i) isolated when the ictal neuronal discharge remains confined to the occipital region; (ii) followed by hemiclonic or automatic or cephalalgic manifestations when the occipital discharge extends to the central or temporal regions or to the brain stem. The observed symptomatology, associated with a family history of epilepsy in 36% of cases, confirms that this syndrome is indeed true epilepsy and not basilar migraine with severe epileptiform abnormalities as supposed by Camfield et al. (1978). Benign epilepsy of childhood with occipital S.W. is essentially functional in nature, depending on epileptic predisposition acting to uncover a minimal brain lesion probably acquired at birth. The prognosis is good, although less satisfactory than that of benign epilepsy with rolandic spikes.