Extraoccipital benign childhood partial seizures with ictal vomiting and excellent prognosis

Area of Science:

• Pediatric Neurology
• Epileptology
• Clinical Neurophysiology

Background:

• Ictal vomiting is a rare seizure manifestation in children.
• Early onset benign childhood occipital seizures (EBOS) is a recognized syndrome associated with ictal vomiting.
• The clinical and EEG characteristics of childhood partial seizures with ictal vomiting and non-occipital EEG foci require further investigation.

Purpose of the Study:

• To describe the clinical features and long-term prognosis of children with partial seizures manifesting as ictal vomiting.
• To investigate the EEG findings in these patients, including those with extraoccipital foci or normal EEGs.
• To determine if these cases represent a distinct epilepsy syndrome or a variant of known benign childhood epilepsies.

Main Methods:

• Prospective follow-up of nine children with ictal vomiting and extraoccipital or normal EEG findings.
• Detailed clinical assessment including neurological examination, developmental assessment, and seizure semiology.
• Long-term EEG monitoring and analysis of seizure frequency and remission.

Main Results:

• All nine children had normal neurological, mental, and developmental status.
• Seizures predominantly occurred during sleep and presented with varied symptoms including vomiting, eye deviation, speech arrest, and hemiconvulsions.
• Median age of onset was 5 years, with infrequent seizures and remission by a median age of 6 years, indicating an excellent prognosis.

Conclusions:

• Idiopathic childhood partial seizures with ictal vomiting can occur with EEG abnormalities outside the occipital regions or with normal EEG findings.
• These seizures share an equally excellent prognosis with EBOS, despite some clinico-EEG differences.
• The findings support a unified concept of benign childhood partial seizure susceptibility syndrome, encompassing seizures with varied EEG foci.