Paroxysmal Visual Disturbances of Epileptic Origin and Occipital Epilepsy in Children

Deonna, T; Ziegler, Anne‐Lise; Despland, P. A.

doi:10.1055/s-2008-1052355

Cited by 21 publications

(14 citation statements)

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“…This was followed by alteration of consciousness and eye deviation. This overlap of ictal visual symptoms and tonic eye and head deviation in the same patients has been reported previously (3,5,11,14,33). Patients with visual symptoms and without adversive manifestations accounted for only 3.7% of the entire cohort, as also reported in one study (11).…”

Section: Figsupporting

confidence: 61%

Childhood Epilepsy With Occipital Paroxysms: Clinical Variants in 134 Patients

2000

Epilepsia

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Summary:Purpose: In its recent proposal, the Commission on Classification and Terminology of the International League Against Epilepsy classified childhood epilepsy with occipital paroxysms (CEOP) into two syndromes with different predominant seizure types: early onset (Panayiotopoulos type) with eye deviation and ictal vomiting and late onset (Gastaut type) with initial ictal visual symptoms. We documented the clinical features of a large group of patients with CEOP to confirm whether the classification is justified.Methods: A file review of all patients with partial-onset seizure and interictal occipital spikes referred to our pediatric seizure unit between January 1975 and May 1997 yielded 134 who met the criteria for CEOP. Data were collected with a specially developed protocol and classified according to the two International League Against Epilepsy systems: (a) seizure classification, to test age-specific differences associated with the predominant seizure type, and (b) syndrome classification, to determine whether the clusters of signs and symptoms are sufficiently delineated.Results: Three groups were defined according to the predominant ictal manifestations. Group 1 (visual) consisted of 24 patients (17.9%) with ictal visual symptoms; 19 (14%) of these patients also had overlapping adversive manifestations, either as a separate seizure or as part of the same event (median age at first and last seizure, 7 years 11 months and 10 years). Group 2 (adversive) consisted of 72 patients (53.7%) with tonic eye deviation (median age at first and last seizure, 5 years 2 months and 7 years 2 months). Group 3 (nonvisual, nonadversive) consisted of 38 patients (28.4%) with various seizure spread patterns (median age at first and last seizure, 6 and 7 years 2 months). Two syndromes were identified. The Gastaut type included all 24 patients in the visual group (group 1); seizures were brief and frequent and were diurnal in 83%. The Panayiotopoulos type included all 72 patients in group 2; ictal eye deviation occurred in 100% of the patients and ictal vomiting in 44%; prolonged seizures were observed in 35% and were more frequent in patients who had ictal vomiting than in those who did not (46.8% versus 25%, respectively; p < 0.027). Seizures were infrequent; 24% of patients had a single seizure and 58% had nocturnal seizures. Onset was earlier than for the Gastaut type (p < 0.002). The 38 patients with nonoccipital manifestations did not satisfy the criteria for the complete form of either syndrome.Conclusions: The most common type of CEOP, the Panayiotopoulos type, is characterized by a cluster of signs and symptoms sufficiently delineated to justify their separate classification from Gastaut-type CEOP, despite the absence of ictal vomiting in more than 50% of the patients.

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Section: Figsupporting

confidence: 61%

Childhood Epilepsy With Occipital Paroxysms: Clinical Variants in 134 Patients

2000

Epilepsia

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“…The occurrence of RS exclusively during sleep in a child with several normal waking tracings whose first sleep EEG obtained after sleep deprivation showed central spikes with a clinical seizure is an example. One child with visual seizures and occipital spike waves blocked by eye-opening fit the syndrome reported recently as "benign epilepsy with occipital spike waves" (Gastaut, 1982), indicating that it is a rare syndrome indeed if its existence and good prognosis can be confirmed (Deonna et al, 1983;Newton and Aicardi, 1983).…”

Section: Discussionmentioning

confidence: 97%

Partial Epilepsy in Neurologically Normal Children: Clinical Syndromes and Prognosis

et al. 1986

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A clinical and electroencephalographic study of 107 neurologically normal children with partial seizures was undertaken to verify the existence and determine the frequency of epileptic syndromes reported in selected populations. Sixty-three children had simple partial seizures, 39 had complex partial seizures, and 5 children were unclassifiable. The syndrome of benign partial epilepsy of children with rolandic spikes (BPEC, 38 cases) was clearly identified and its uniformly benign final prognosis was confirmed even if some of these children had at times severe or poorly controlled seizures. Among the children with simple partial seizures outside the BPEC (25 cases) and complex partial seizures (39 cases), no homogeneous clinical or electroclinical subgroup could be found. Two children with benign partial epilepsy and myoclonic-astatic seizures ("atypical benign partial epilepsy of childhood") and one child with "benign epilepsy with occipital spike-waves" were identified. 74% of children with epilepsy with complex partial seizures (ECP) had a 1-year seizure-free interval, and many children with epilepsy with simple partial seizures outside the BPEC group (ESP) had no more than two seizures. A benign course is thus not limited to the BPEC but is difficult to predict. Prospective studies are necessary to confirm the existence of well-defined benign syndromes among the idiopathic partial epilepsies of childhood, which appear quite rare outside the BPEC.

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“…In those cases it is often a postictal manifestation. When ictal in nature, amaurosis is often of short duration (14). However, cases of status amauroticus lasting several days have been described (15 Visual illusions have also been reported in patients with possible occipital lobe epilepsy (16).…”

Section: Ictal Amaurosis and Other Visual Changesmentioning

confidence: 99%

Symptomatic Occipital Lobe Epilepsy

Kuzniecky

1998

Epilepsia

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Summary: Symptomatic occipital lobe epilepsy is increasingly recognized among patients with partial-onset seizures. Although traditional clinical and electroencephalographic criteria had defined occipital lobe epilepsy in the past, new neuroimaging techniques and the recognition of specific syndromes associated with occipital lobe epilepsy have improved the diagnosis and management of these patients. These syndromes include, among others, lesional occipital lobe epilepsy (congenital vs. acquired), MELAS, and epilepsy with bilateral occipital calcifications. The diagnosis of symptomatic occipital lobe epilepsy is improving as functional and structural neuroimaging techniques enable the detection of subtle abnormalities in such patients. This has had a direct impact on the correct classification of patients with benign occipital lobe epilepsy, basilar migraine, and symptomatic occipital lobe epilepsy. The common clinical symptoms, EEG patterns, and neuroimaging findings of these patients are discussed. Key Words: Occipital lobe epilepsy-congenital vs. acquired syndromes-EEG patterns-Neuroimaging.Advances in the diagnosis of epilepsy have led to refinements in the classification of the epilepsies. This has been primarily possible because of recent major advances in neuroimaging techniques, which are now able to detect pathology in many patients with temporal lobe epilepsy, particularly in those with mesial temporal lobe sclerosis. This capability, in addition to the wealth of new noninvasive imaging techniques, has directed efforts toward the better definition of extratemporal lobe epilepsies. This article describes the clinical features associated with symptomatic occipital lobe epilepsy and reviews the etiologic factors, imaging and electrographic characteristics, and outcome. EPIDEMIOLOGIC ASPECTSThe relative incidence of symptomatic occipital lobe epilepsy is unknown (1). No prospective studies are available, and most retrospective series have selected patients on the basis of EEG abnormalities or of EEG and clinical features suggestive of occipital lobe epilepsy, and have included those with benign syndromes. Furthermore, previous studies have included children and adults and have been influenced by the referral patterns of the reporting centers. An EEG-based survey reported 8% of the population as having occipital seizures. An Italian study (2) reported that occipital epilepsy consti- tuted 11% of symptomatic partial epilepsies in children.Other centers report frequencies ranging from 4 to 13%.In contrast, data from epilepsy surgery centers suggest that occipital lobe resections constitute less than 5% of operated patients (3). The available data, however, are an underestimation of the relative frequency of occipital seizures. This is a reflection of the fact that a sizable number of patients with occipital lobe epilepsy are not correctly diagnosed or are not candidates for epilepsy surgery. CLINICAL SYMPTOMS OF OCCIPITAL LOBE EPILEPSYThe symptomatology of occipital lobe epilepsy was described as early as 188...

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Paroxysmal Visual Disturbances of Epileptic Origin and Occipital Epilepsy in Children

Cited by 21 publications

References 2 publications

Childhood Epilepsy With Occipital Paroxysms: Clinical Variants in 134 Patients

Childhood Epilepsy With Occipital Paroxysms: Clinical Variants in 134 Patients

Partial Epilepsy in Neurologically Normal Children: Clinical Syndromes and Prognosis

Symptomatic Occipital Lobe Epilepsy

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