Abstracts

Benign childhood epilepsy with occipital paroxysms (CEOP) is an idiopathic partial epilepsy syndrome characterized by elementary visual seizure semiology, often associated with other ictal phenomena. Symptomatic occipital epilepsy (SOE) is increasingly recognized among patients with focal seizures. We aimed to evaluate clinical features, EEG, and seizure outcome in children with occipital epilepsy. We studied 30 children diagnosed with occipital epilepsy. All patients had routine EEG and MRI; VEP was performed in 25 patients. Twenty patients were classified as idiopathic occipital epilepsy (IOE); 10 patients (33%) as CEOP Panayiotopoulos type, 8 ( 27% ) as CEOP Gastaut type, 2 (7%) as idiopathic photosensitive occipital epilepsy. Ten patients (33%) were classified as SOE. The age at the time of study ranged between 2.5-16.5 years (mean: 8.8 years); age at seizure onset was between first day of life-13 years (mean: 4.9 years). The mean follow-up duration ranged from 3 months to 8.5 years (mean: 2.4 years). Twelve patients (40%) experienced visual aura; 8 and 4 patients in the IOE and SOE groups respectively. Nine out of 10 patients with ictal blindness had IOE. Other semiological features included ictal vomiting and headaches. Two patients (7%) had initially normal routine EEG, 3 patients had sleep activated discharges, and 2 had photoparoxysmal response. VEP was available in 5 patients with SOE, and were abnormal; all patients with IOE had normal VEP results. MRI showed bilateral occipital lesions in 4 of 10 patients with SOE and unilateral occipital lesions in 5. One patient showed diffuse atrophy along with right sided pachygyria. Seven of 10 patients with SOE had a history of neonatal hypoglycemia. Overall 22 patients (73%) achieved seizure control at last follow-up visit. One of 8 patients with COEP Gastaut type, and 7 of 10 patients with SOE had recurring seizures. Neuropsychological evalution revealed difficulty with visual-spacial tasks in patients with SEO. Seizure semiology included visual symptoms predominantly in patients with IOE. Majority of the patients with IOE had visual symptoms and vomiting which may mimic migraine head aches. Seizure outcome is markedly favorable in patients with IOE compared to SOE. History of neonatal hypoglycemia was common among patients with SOE. Neonatal hypoglycemia affects the parieto-occipital areas most and should be considered in the etiology of SOE. Long term follow-up is necessary to evaluate behavioral outcome and cognitive difficulties in each group. (Dr. Dilek Yalnizoglu is supported by NIMH ICORTHA Fogarty International Mental Health and Developmental Disabilities Research Training Program (D43TW05807) at Children[apos]s Hospital Boston; PI: K. M. Munir.)