The EEG in childhood epilepsy with occipital paroxysms (CEOP) was termed "distinctive" by Gastaut (1985) and Talwar et al. (1992) and "characteristic" by Herranz Tanarro et al. (1984), which suggests that the EEG is specific and diagnostic for CEOP. However, this hypothesis has been challenged (Newton and Aicardi, 1983; Beaumanoir and Grandjean, 1987). To test this, we reviewed 5,291 EEG reports made in 5 1/2 years in the only tertiary pediatric center in Newfoundland and Labrador. We identified 31 children who had one or more EEGs with occipital spike/sharp waves showing suppression of discharges with eye opening and normal background activity. Six had CEOP, 17 had benign nocturnal childhood occipital epilepsy, 5 had symptomatic epilepsy, 3 had unusual complex partial seizures (CPS), 4 had only provoked seizures, and 2 had no definite seizures. Overlap between seizure types was common. The EEG criteria for CEOP are not very specific.

Three patients had a clinical history of epileptic seizures during exercise. In all three patients, generalized epileptiform EEG abnormalities were activated by exercise, whereas none had paroxysms during resting wakefulness or during hyperventilation, and only one had a paroxysmal discharge during sleep. Advice to epileptic patients about physical activity should be based on a careful history of individual tolerance. In doubtful cases, an EEG recorded during exercise can provide evidence for an epileptic mechanism.

Background: The relationship of ictal and post-ictal cephalic pain to migraine remains debatable. We hereby report 2 patients whose post-ictal migraine-like symptoms ameliorated in response to oral sumatriptan. Methods: Two patients, a 27-year-old woman and 41-year-old man were referred for assessment of migraine of 10 years and 4 years duration, respectively. The man described a recent episode of "vacant stare" and the woman has sensitivity to bright colours and light. Neurological examination, visual field testing, CAT scan, MRI scan, and prolonged EEG recordings were accomplished for each patient. Results: The man had a spontaneous seizure with ictal discharge arising from the right occipital lobe. Bilateral occipital spikes, associated with palinopsia was triggered in the woman by photic stimulation. Both patients developed post-ictal headaches with symptoms similar to their migraines. The symptoms subsided following treatment with oral sumatriptan. Conclusion: Migraine-like symptoms occurring following occipital lobe seizures may share similar pathophysiological substrates with idiopathic migraine. Serotonergic mechanisms may be implicated. RESUME: Manifestations d'allure migraineuse declenchees par de l'epilepsie occipitale: reponse au sumatriptan. Introduction: La relation entre la cephalee ictale et post-ictale et la migraine demeure controvers£e. Nous rapportons le cas de 2 patients dont les symptomes d'allure migraineuse ont bien r£pondu a I'administration orale de sumatriptan. Methodes: Deux patients, une femme de 27 ans et un homme de 41 ans, ont €l6 rdf£r£s pour Evaluation de migraines presentes depuis 10 ans et 4 ans respectivement. L'homme a decrit un episode recent de regard fixe et vague et la femme avait une hypersensibilitd aux couleurs vives et h la lumiere. On a proc6d6 a un examen neurologique, des champs visuels, un CAT scan, une RMN et des enregistrements EEG prolonged chez chaque patient. Resultats: L'homme a eu une crise spontanee avec une decharge ictale provenant du lobe occipital droit. Des pointes occipitales bilaterales associees a une palinopsie ont 6t6 d£clenchees chez la femme par stimulation photique. Les deux patients ont developpfi une cephalee post-ictale accompagnee de symptomes semblables a leurs migraines. Les symptomes ont rdgresse avec I'administration orale de sumatriptan. Conclusions: Les symptomes d'allure migraineuse survenant suite a de l'epilepsie occipitale peuvent avoir des bases physiopathologiques semblables a celles de la migraine idiopathique. Des mecanismes seYotoninergiques pourraient etre impliquSs.Can. J. Neurol. Sci. 1998; 25: 151-153 That a link exists between epilepsy and migraine has been debated for over a century. Liveing sparked the controversy by describing migraine as resulting from "nerve storm" in the brain, akin to epilepsy. 1 Gowers also supported the contention that migraine and epilepsy originated from disturbances of the cerebral cortex and included migraine in the borderline of epilepsy. 2 In the last 20 years, interest in t...

Cocaine abuse is associated with a variety of severe acute neurologic complications typically occurring in the abusers themselves. These include ischemic stroke, subarachnoid and intraparenchymal hemorrhage, headaches, syncope, seizures, and death. Sixteen pediatric patients with presumed cocaine-related seizures secondary to maternal consumption are reported. They were evaluated only because of requests for neurologic consultation. All were seen during the 1987 calendar year at the King/Drew Medical Center and Urban Comprehensive Epilepsy Program of Los Angeles. The cohort had similar maternal pregnancy histories and uniformly presented with postdelivery tremulousness, irritability, and excessive startle responses. Shortly after birth, each patient began having stereotypic episodes with ictal electroencephalographic confirmation in seven. Eight of these neonates continued to have seizures after the initial month of life.

Background: The term, "triphasic wave" originally described an EEG pattern believed to be a marker for a specific stage of hepatic coma. For 4 decades, the diagnostic and prognostic specificity of the pattern remains controversial. Its pathophysiology also continues to be elusive. Methods: EEG recordings were obtained in three patients known or suspected to have primary generalized epilepsy. In 2 patients, the EEGs were part of long-term monitoring using simultaneous video-EEG telemetry. For the third patient, the EEG was secured only during the post-ictal unconsciousness. These 3 patients were specifically selected because of the presence of triphasic waves in their EEGs. Results: Triphasic waves were observed in the EEG of the 3 patients only during post-ictal unconsciousness. The pattern was transient, being preceded by generalized suppression and delta slow waves and followed by theta activities. Alpha rhythms supervened when the patients became fully alert. Conclusion: A post-ictal state should be considered in unconscious patients with triphasic EEG waves. RESUME: Ondes triphasiques pendant la stupeur postcritique. Introduction: On parlait initialement d'onde triphasique pour decrire un motif EEG qu'on croyait etre un marqueur d'un stade specifique du coma hepatique. Pendant 4 decennies, la specificite diagnostique et pronostique de ce motif sont demeurees un sujet de controverse. Sa pathophysiologic demeure egalement obscure. Methodes: Nous avons obtenu des enregistrements EEG chez trois patients avec un diagnostic certain ou soup$onne d'epilepsie generalisee primaire. Chez 2 patients, l'EEG faisait partie du suivi a long terme associe a la telemesure video-EEG. Chez le troisieme patient, l'EEG a ete enregistre seulement pendant la peYi-

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A 53-year-old woman with a history of chronic abuse of "crack" cocaine developed isolated complex partial status epilepticus after 3 days of frequent cocaine use. The electroencephalogram demonstrated focal epileptiform activity. Follow-up for 1 year during which she reported continuous abstinence from cocaine and anti-convulsants revealed no recurrence of seizures.

Migraine with prolonged aura has rarely been examined with regard to the sequence of the neurological symptoms and the associated EEG changes. This report describes five patients who underwent clinical assessment and EEG recordings during attacks of migraine with prolonged aura. CT scan of the brain was obtained in four of them. Follow-up EEG was also obtained. The aura symptoms either preceded the headache or were coincident with it. The aura symptoms evolved in a manner consistent with posterior-to-anterior dysfunction of the cerebral cortex. The EEG abnormalities were non-epileptiform and consisted of focal delta slow waves or theta slow waves. The EEG abnormalities showed good correlation with the patients' aura symptoms and resolved when the patients became symptom free. The posterior-to-anterior sequence of the aura symptoms is in accord with the findings during cerebral blood flow studies in patients having migraine with aura. Also the symptoms and EEG changes in our patients indicate dysfunction of the cerebral cortex, consistent with the notion that spreading cortical depression may be the underlying pathophysiological event in migraine with aura.