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Childhood occipital epilepsy: seizure manifestations and electroencephalographic features
A D Yalçin1, A Kaymaz, H Forta
1Department of Neurology, Sişli Etfal Education Hospital, Istanbul, Turkey.
Insights
Childhood epilepsy with occipital paroxysms (CEOP) and benign nocturnal childhood occipital epilepsy (BNCOE) share similar EEG features. Seizure symptoms are crucial for diagnosing CEOP and BNCOE, even with normal EEG findings.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Background:
- Childhood epilepsy with occipital paroxysms (CEOP) is an idiopathic localization-related epilepsy.
- Benign nocturnal childhood occipital epilepsy (BNCOE) presents with nocturnal seizures and shares EEG features with CEOP.
Purpose of the Study:
- To analyze seizure symptoms and electroencephalographic (EEG) features in 21 cases of CEOP or BNCOE.
- To highlight the diagnostic importance of clinical presentation in these conditions.
Main Methods:
- Case series analysis of 21 patients diagnosed with CEOP, BNCOE, or overlapping syndromes.
- Detailed recording and evaluation of seizure semiology and EEG findings, including occipital paroxysms.
Main Results:
- Nine patients had BNCOE, six had CEOP, and four had overlapping features; two presented with incomplete syndromes (normal EEG).
- BNCOE patients reported visual symptoms upon waking with eye deviation and vomiting.
- CEOP patients experienced visual aura followed by loss of consciousness without generalized convulsions.
Conclusions:
- Seizure symptomatology is a critical diagnostic factor for CEOP and BNCOE, even when EEG appears normal.
- The presence of additional centro-temporal or generalized discharges supports the idiopathic nature of these epilepsies.
Abstract:
Childhood epilepsy with occipital paroxysms (CEOP) is an idiopathic localization-related epilepsy. A typical seizure in CEOP begins with visual symptoms, followed by hemiclonic seizures, complex partial seizures or generalized tonic-clonic seizures. Benign nocturnal childhood occipital epilepsy (BNCOE), characterized by nocturnal seizures with tonic deviation of the eyes followed by vomiting, has the same electroencephalographic features as CEOP. In this study, we report the seizure symptoms and electroencephalographic features of 21 cases with CEOP or BNCOE. Out of these patients, nine had BNCOE, six had CEOP, four had CEOP and BNCOE and the remaining two belonged to the incomplete syndrome because of no paroxysmal discharges in EEG. When the patients with BNCOE awoke from sleep, they had tonic deviation of the eyes and could describe visual symptoms. Patients with CEOP had seizures beginning with visual symptoms followed by loss of consciousness but no generalized convulsions. In three cases, in addition to the occipital spikes, independent centro-temporal spikes were recorded and in another three cases generalized spike-wave discharges were recorded. Such a combination suggests the idiopathic nature of these epilepsies. We concluded that in the diagnosis of CEOP and BNCOE, the seizure symptomatology is important even if the EEG can be considered normal.