Occipital Spikes Research Articles

Teaching NeuroImage: Subharmonic Frequency Occipital Spikes.

Teaching NeuroImage: Subharmonic Frequency Occipital Spikes.

Atypical electroclinical presentation of Landau Kleffner syndrome: a case report of an 8 year old Nigerian child

Epileptic seizures account for common neurologic presentations in paediatric neurology units in developing countries. Atypical presentation of syndromic epilepsy may be missed especially sensory, psychic or autonomic manifestations. An 8 year old male Nigerian child presented with recurrent vomiting and delayed motor milestones, regression of speech (acquired aphasia) with unremarkable birth history or any underlying medical or surgical condition. He had delayed gross motor development and continuous bilateral polyspike waves of slow sleep on EEG. Self-limited autonomic epileptic seizure syndrome which was a strong differential of autonomic seizures in early childhood was not suggestive as his EEG findings failed to demonstrate occipital spike wave pattern nor did photic stimulation evoke any epileptiform waves. Child made significant clinical improvement with anticonvulsants, neuro vitamins, and behavioural therapy, evidenced by regain of non-verbal communication, resolution of autonomic symptoms and temper tantrums. A high index of suspicion should be applied in patients with acquired aphasia with subclinical or recurrent autonomic symptoms.

Normal variants and artifacts: importance in EEG interpretation.

Overinterpretation of EEG is an important contributor to the misdiagnosis of epilepsy. For the EEG to have a high diagnostic value and high specificity, it is critical to recognize waveforms that can be mistaken for abnormal patterns. This article describes artifacts, normal rhythms, and normal patterns that are prone to being misinterpreted as abnormal. Artifacts are potentials generated outside the brain. They are divided into physiologic and extraphysiologic. Physiologic artifacts arise from the body, and include EMG, eyes, various movements, EKG, pulse, and sweat. Some physiologic artifacts can be useful for interpretation such as EMG and eye movements. Extraphysiologic artifacts arise from outside the body, and in turn can be divided into the environments (electrodes, equipment, cellphones) and devices within the body (pacemakers, neurostimulators) Normal rhythms can be divided into awake patterns (alpha rhythm and its variants, mu rhythm, lambda waves, posterior slow waves of youth, HV-induced slowing, photic driving, photomyogenic response) and sleep patterns (POSTS, vertex waves, spindles, K complexes, sleep-related hypersynchrony, frontal arousal rhythm). Breach can affect both awake and sleep rhythms. Normal variants or variants of uncertain clinical significance include variants that may have been considered abnormal in the early days of EEG but are now considered normal. These include wicket spikes and wicket rhythms (the most common normal pattern over-read as epileptiform), small sharp spikes (aka benign epileptiform transients of sleep), rhythmic midtemporal theta of drowsiness (aka psychomotor variant), Cigánek rhythm (aka midline theta), 6 Hz phantom spike-wave, 14&6 Hz positive spikes, subclinical rhythmic epileptiform discharges of adults (SREDA), slow fused transients, occipital spikes of blindness, and temporal slowing of the elderly. Correctly identifying artifacts and normal patterns can help avoid overinterpretation and misdiagnosis. This is an educational review paper addressing a learning objective of the International League Against Epilepsy (ILAE) curriculum.

Teaching NeuroImage: Needle-like Occipital Spikes in Children With Visual Impairment.

We report an 8-year-old boy with bilateral optic nerve hypoplasia and cortical visual impairment with an ASTN1 (OMIM#600904) variant. EEG was ordered for screening purposes because there was no history of seizures/epilepsy. EEG showed absence of posterior dominant rhythm and focal needle-like spike-and-wave discharges in the left occipital region (Figure). It is unclear whether the ASTN1 mutation contributed to this patient's phenotype. EEGs of children with visual dysfunction commonly show absence of posterior dominant rhythm and may show occipital needle-like spikes, which are considered innocuous and unrelated to epilepsy thus a normal EEG variant, and may be due to functional deafferentation.1,2

Epilepsy syndromes in cerebral palsy: varied, evolving and mostly self-limited.

Seizures occur in approximately one-third of children with cerebral palsy. This study aimed to determine epilepsy syndromes in children with seizures and cerebral palsy due to vascular injury, anticipating that this would inform treatment and prognosis. We studied a population-based cohort of children with cerebral palsy due to prenatal or perinatal vascular injuries, born 1999-2006. Each child's MRI was reviewed to characterize patterns of grey and white matter injury. Children with syndromic or likely genetic causes of cerebral palsy were excluded, given their inherent association with epilepsy and our aim to study a homogeneous cohort of classical cerebral palsy. Chart review, parent interview and EEGs were used to determine epilepsy syndromes and seizure outcomes. Of 256 children, 93 (36%) had one or more febrile or afebrile seizures beyond the neonatal period and 87 (34%) had epilepsy. Children with seizures were more likely to have had neonatal seizures, have spastic quadriplegic cerebral palsy and function within Gross Motor Function Classification System level IV or V. Fifty-six (60%) children with seizures had electroclinical features of a self-limited focal epilepsy of childhood; we diagnosed these children with a self-limited focal epilepsy-variant given the current International League Against Epilepsy classification precludes a diagnosis of self-limited focal epilepsy in children with a brain lesion. Other epilepsy syndromes were focal epilepsy-not otherwise specified in 28, infantile spasms syndrome in 11, Lennox-Gastaut syndrome in three, genetic generalized epilepsies in two and febrile seizures in nine. No epilepsy syndrome could be assigned in seven children with no EEG. Twenty-one changed syndrome classification during childhood. Self-limited focal epilepsy-variant usually manifested with a mix of autonomic and brachio-facial motor features, and occipital and/or centro-temporal spikes on EEG. Of those with self-limited focal epilepsy-variant, 42/56 (75%) had not had a seizure for >2 years. Favourable seizure outcomes were also seen in some children with infantile spasms syndrome and focal epilepsy-not otherwise specified. Of the 93 children with seizures, at last follow-up (mean age 15 years), 61/91 (67%) had not had a seizure in >2 years. Children with cerebral palsy and seizures can be assigned specific epilepsy syndrome diagnoses typically reserved for normally developing children, those syndromes commonly being age-dependent and self-limited. Compared to typically developing children with epilepsy, self-limited focal epilepsy-variant occurs much more commonly in children with cerebral palsy and epilepsy. These findings have important implications for treatment and prognosis of epilepsy in cerebral palsy, and research into pathogenesis of self-limited focal epilepsy.

Self-Limited Epilepsy with Autonomic Seizures (SeLEAS): A Retrospective Case Series

Abstract Objective Self-Limited Epilepsy with Autonomic Seizures (SeLEAS), previously known by the eponymous Panayiotopoulos syndrome, is a benign focal epilepsy of the pediatric age group. It is characterized by nocturnal seizures with dominant autonomic features. Limited data from India exists on SeLEAS. We aimed to describe the clinical, demographic, and treatment-related features of SeLEAS. Methods In this descriptive retrospective cohort study, we reviewed record of children who met criteria for SeLEAS. Each patient's clinical, demographic, electroencephalographic, neuroimaging, and treatment details were reviewed. Response to antiseizure medications was also recorded. Results Twenty-three children with SeLEAS were enrolled (males = 18; 78.2%). Median age at onset was 4 (interquartile range: 2.5–10) years and median age at presentation was 6 (2.5–11) years. Focal seizures were observed in 65.2% (n = 15) and 30% (n = 7) had history of status epilepticus. Ictal/postictal emesis was observed in all patients. Occipital spikes on electroencephalography were seen in 78% (n = 17). Four children had poor scholastic performance. Most (70%) of patients were well controlled on monotherapy, even with older antiseizure medications. Conclusion This cohort shows the spectrum of clinical heterogeneity associated with SeLEAS. Although considered benign, occurrence of status epilepticus and poor scholastic performance among some of our patients suggests that some caution may be appropriate while prognosticating such patients. Seizures were well controlled with monotherapy.

P.095 The many clinical facets of pediatric occipital spikes and the predictive value of consistent EEG dipole

Background: Pediatric occipital epileptiform discharges (OEDS) occur in various clinical settings, including benign and symptomatic epilepsies. The study objective is to determine electro-clinical predictors for aetiology and prognosis in children with OEDs. Methods: 205 patients with OEDs were classified into seizure groups: symptomatic (n=98), idiopathic focal (IF) (n=57), idiopathic generalized (IG) (n=18), no-seizures (n=27) and febrile seizures (n=5). Results: The median age of seizure onset was 3 years (range: 0-19). There was more EEG background slowing (P<0.05) in the symptomatic; photosensitivity (P<0.0001) and GSW (P<0.0001) in IG; and presence of consistent EEG spike dipole in IF group. The symptomatic had more DD (P< 0.0001), autism (P <0.019), and school difficulties (P<0.001) than the IF and IG groups, but not different from the no-seizure group. Conclusions: OEDs with consistent dipole spike is predictive of IF epilepsy. In contrast to frontal and temporal lobe epilepsy, only 30% with symptomatic epilepsy had occipital-predominant neuro-imaging abnormalities. Notably, neuro-psychiatric co-morbidities were similar between the symptomatic and no-seizure group.

Hyperglycemia‐induced seizures and visual symptoms due to reversible occipital damage: A case series

AbstractSeizures associated with hyperglycemia are mostly partial motor with or without secondary generalization. Occipital lobe seizures due to hyperglycemia have been reported in few case studies. The clinical characteristics, electroencephalogram (EEG), and imaging findings of the patients with poorly controlled sugars, visual impairment, and seizures were analyzed. Three patients presented with poorly controlled sugars, seizures, and visual symptoms including visual impairment and occipital seizures over a period of 6 months. EEG showed frequent occipital spikes and electrical seizures of occipital origin. Magnetic resonance imaging brain showed T2 FLAIR hypointensity over the subcortical white matter and gyral changes over the parieto‐occipital area. All of them showed good clinical improvement with antiepileptic medications and good glycemic control. The imaging repeated on follow‐up in two patients showed complete resolution of T2 FLAIR hypointensity. Hyperglycemia‐induced changes can occur with a predeliction for occipital lobe. The visual impairment and occipital seizures respond to glycemic control and anticonvulsants.

Pediatric Occipital Spikes at a Single Center Over 26 Years and the Significance of Tangential Dipole.

Pediatric occipital epileptiform discharges occur in various clinical settings, including self-limited and treatment-resistant epilepsies. The study objective is to determine electro-clinical predictors for prognosis in children with occipital epileptiform discharges. 205 patients with occipital epileptiform discharges were classified into seizure groups: self-limited occipital (SLO) (n = 57), including Panayiotopoulos and Gastaut syndrome; non-self-limited occipital (non-SLO) (n = 98), including various seizure etiologies; genetic-generalized (n = 18); febrile (n = 5); and no-seizure (n = 27) groups. Electro-clinical features of the SLO and non-SLO were compared, as this is of most clinical relevance. The median age of seizure onset was 3 years (range: 0-19). Occipital epileptiform discharges with frontal/central positivity were present in both groups, but more common in the SLO than non-SLO groups; 21/57 (36.8%) and 19/98 (19.4%), respectively (P < .022). However, when occipital epileptiform discharges with tangential dipoles (P < .048) were accompanied by abnormal ictal eye movements (P < .037), they were predictive of SLO epilepsy. In our cohort, occipital epileptiform discharges with tangential dipole detected by visual analysis and abnormal ictal eye movements were predictive of SLO epilepsy.

Panayiotopoulos syndrome: A benign childhood epilepsy syndrome masquerading as head injury

Panayiotopoulos syndrome (PS) is a benign childhood epilepsy syndrome characterized by autonomic seizures and electroencephalogram (EEG) showing predominant occipital paroxysms. PS may easily be confused with many non-epileptic conditions such as atypical migraine, gastroenteritis, or syncope. We here present a 5 ½-year-old boy who presented to us with a history of head injury followed by vomiting, seizures, and prolonged unresponsiveness. Neuroimaging was normal, and on detailed history, it was clear that autonomic symptoms preceded the head injury and so an EEG was done. Interictal EEG showed bilateral occipital spikes and wave discharges with characteristic “fixation-off sensitivity.” Hence, the seizure semiology along with the EEG pattern helped to clinch the diagnosis. Parents were counseled about the benign nature of the condition

Electroclinical spectrum of childhood epilepsy secondary to neonatal hypoglycemic brain injury in a low resource setting: A 10-year experience

PurposeNeonatal hypoglycemic brain injury (NHBI) is being increasingly recognized as an important cause of drug resistant childhood epilepsy in low resource settings. We report the electro-clinical spectrum of children with epilepsy secondary to NHBI. MethodsThis was a retrospective study of children enrolled in the Epilepsy Clinic from January 2009 to August 2019. Data of children who had developed epilepsy after documented symptomatic neonatal hypoglycemia was collected. Details of clinical profile, seizure types, neurodevelopmental co-morbidities, EEG, neuroimaging findings and seizure outcomes were noted. ResultsOne hundred and seventy children were enrolled. The mean age at seizure onset was 10.3 months (SD 0.5 months). The seizures types were epileptic spasms (76.5%), focal with visual auras (11.2%), bilateral tonic clonic (7.1%), myoclonic (3.5%) and atonic seizures (1.8%). The EEG findings included classical hypsarrhythmia (49.4%), hypsarrhythmia variant (27.1%), focal occipital or temporo-occipital spike wave discharges (10.6%), multifocal discharges (4.7%), diffuse slow spike and wave with bursts of fast rhythms (2.4%), continuous spike waves during sleep (1.2%) and normal EEG (4.7%). MRI showed gliosis with or without encephalomalacia in the occipital lobe with or without parietal lobe in 96.5% of the patients. Co-morbidities included global developmental delay (91.2%), cerebral palsy (48.7%), vision impairment (48.2%), microcephaly (38.2%), hearing impairment (19.4%), and behavioural problems (16.5%). Drug resistant childhood epilepsy was seen in 116 (68.2%) patients. ConclusionsOur study highlights the varied electroclinical and radiological spectrum and the adverse epilepsy and neurodevelopmental outcomes associated with NHBI.

Interpretation of electroencephalography in infants

Aim: Based on published reports and our own observations, we aimed to assign the graphical elements of EEG into normal and abnormal groups and then identify up to five main graphic elements in each group to facilitate visual analysis and interpretation of EEG in young children.Materials and methods. We searched for the relevant sources in the Medline and Medscape databases using the following keywords: «neonatal EEG», «neonatal seizures», «theta burst», «delta brushes», «trace discontinue», «burst-suppression», hypsarrhythmia», etc. Our own research was conducted using an Encephalan-EEGR-19/26 encephalograph equipped with children size gold cup electrodes with a diameter of 0.6 cm. Encephalograms were recorded from 10 electrodes according to the international “10-20” system.Results and discussion. In early childhood EEGs, two large groups of EEG graphic elements can be discerned: the likely normative graphic elements and patterns of pediatric EEG (normal patterns) and the likely non-normative (abnormal) graphic elements and patterns of pediatric EEG. In the likely normative group, the main features are represented by: theta bursts, delta brushes, the “intermittent EEG curve” pattern, the occipital theta rhythm, and slow-sleep waves. In the likely non-normative group, those are: paroxysmal EEG graphic elements, asynchronous EEG patterns, spike-wave discharges, 3 Hz peak waves, hypsarrhythmia, burst-suppression pattern, rolandic occipital spikes, and a slowing rhythm pattern.Conclusion. Along with the numerous attempts to characterize the age-dependent graphic elements at an early age, there are few reports concerning older children and adults. Here we try to overcome this discrepancy by identifying two large groups of graphic elements in EEG that are similar between infants and children of an older age. Such an approach may contribute to a better understanding of normal and pathological ontogenesis.

C-70 Neuropsychological Profiles of Patients With SCN8A-Related Epilepsy

Abstract Objective Two cases of SCN8A-related epilepsy (a sodium-channelopathy) are presented. SCN8A-related epilepsy with encephalopathy (SCN8A-REE), the most common form, is typically characterized by refractory seizures, developmental delays, and intellectual disability (ID) but recently discovered variants have shown broadly normal cognition. Current cases highlight the heterogeneity seen with differing de-novo pathogenic variants. Method Case 1, a 6-year-old right-handed girl, presented with SCN8A-REE and a missense pathogenic variant (c.802A&gt;C), not previously documented. History includes speech and motor delay, with focal motor seizures starting at 4-months. Early EEG showed bilateral centroparietal epileptiform discharges. Case 2, an 8-year-old right-handed girl, presented with SCN8A-related epilepsy with c.5630A&gt;G pathogenic variant with seizure onset at 5-months. Initial EEG showed right occipital spikes. Results Case 1 currently shows motor and language delays and prominent motor tics. Testing documented ID with fairly global neuropsychological deficits (i.e., academics, attention/executive functions, memory, visual-spatial skills, fine motor, language). In contrast, Case 2 shows low average intellect and average academics, but evaluation documented attention deficits, fine motor delays, and behavioral issues in addition to tics; she was diagnosed with Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Obsessive Compulsive Disorder, and Tourette’s. Conclusion These cases expand limited knowledge regarding neuropsychological functioning of children with SCN8A-related epilepsy with unique de-novo pathogenic variants. While SCN8A-REE is clearly associated with ID, other pathogenic variants may show better preserved intellect, despite other neuropsychological and behavioral concerns.

Progressive myoclonus epilepsy caused by a gain-of-function KCNA2 mutation

Progressive myoclonus epilepsy caused by a gain-of-function KCNA2 mutation

Type III roach scale Sturge-Weber syndrome associated with an extracranial lipoma: A case report

Introduction. Sturge-Weber syndrome is a neurocutaneous disorder characterized by neurological features such as headaches, developmental delay, mental retardation and seizures, facial anomalies such as port-wine stain and glaucoma which is the most common ocular manifestation. The main neuroimaging findings in patients with Sturge-Weber syndrome are leptomeningeal angiomatosis and corticopial calcifications associated with underlying cortical atrophy. The purpose of this report is to present a rare case of a patient with seizures whose magnetic resonance imaging findings suggested a Sturge-Weber syndrome variant. Case Report. We report a case of a 14-yearold boy with a two year history of well controlled generalized tonic clonic seizures with visual aura, who was admitted to our institution for neuroimaging examination. Neuropsychological testing showed normal cognitive and psychomotor development. Electroencephalography revealed unilateral runs of right occipital spikes with secondary generalization. Neuroimaging findings showed focal cerebral leptomeningeal enhancement in the right parasagittal occipital region associated with focal cortical atrophy, whereas susceptibility weighted imaging showed hypointense intracortical calcification and hyperplastic enhanced ipsilateral choroid plexus. The computed tomography confirmed cortical calcifications. Also, an overlying parietooccipital subcutaneous lipoma was found in the innervation field of the ophthalmic nerve. Conclusion. Magnetic resonance imaging is the key imaging modality that confirmed the clinical suspicion of Sturge-Weber syndrome based on a physical and neurological examination. Neither magnetic resonance imaging nor clinical examination is sufficient for a correct diagnosis.

MELAS presenting as occipital lobe epilepsy: Not all occipital epilepsies are benign

We report an 11-year-old boy with normal development who initially presented with visual disturbances (perceiving flashes of light), photosensitivity and eye flickering. An electroencephalogram (EEG) showed occipital spike wave discharges and was treated with levetiracetam. He further developed myoclonic twitches and was investigated. Metabolic screen was negative including a normal brain MRI and normal serum lactate. The patient gained good seizure control with levetiracetam. He later presented with a gradual-onset occipital headache and further visual disturbances. He was found to have a right quadrantinopia and magnetic resonance imaging (MRI) of the brain showed a subacute ischaemia in the left occipital region. Childhood stroke screen was done and no particular cause was found. Serum lactate was again within the normal limits. At 15 years, he presented with an increasing seizure frequency. He developed a visual loss, with headaches, unsteadiness of his gait, slurred speech and fluctuating confusion. Computed tomography of the head showed a combination of anterior and posterior circulation stroke, with involvement of both the right and left posterior cerebral artery. MRI and magnetic resonance angiography showed similar findings. A lumbar puncture revealed high lactate levels in the cerebrospinal fluid. Mutation studies confirmed a diagnosis of MELAS with the A3243G mutation. Many consider occipital epilepsy in the paediatric patient as benign. Upon review of the literature, patients with MELAS have presented with adult-onset occipital seizures. We have identified only two patients, in America and Japan respectively, with MELAS presenting in childhood with occipital lobe epilepsy. However, these patients both presented with status epilepticus, with secondary generalisation. This is the first case to our knowledge of MELAS presenting with recurrent occipital seizures in a paediatric patient without the progression to status epilepticus. This highlights the need to consider MELAS early in childhood occipital epilepsy.

Adult-onset photosensitivity: clinical significance and epilepsy syndromes including idiopathic (possibly genetic) photosensitive occipital epilepsy.

To evaluate the clinical associations of adult-onset photosensitivity, we studied the clinical and EEG data of patients who were referred due to a possible first seizure and who had a photoparoxysmal response on their EEG. Patients with clinical evidence of photosensitivity before the age of 20 were excluded. Of a total of 30 patients, four had acute symptomatic seizures, two had vasovagal syncope, and 24 were diagnosed with epilepsy. Nine of the 24 patients had idiopathic (genetic) generalized epilepsies and predominantly generalized photoparoxysmal response, but also rare photically-induced seizures, while 15 had exclusively, or almost exclusively, reflex photically-induced occipital seizures with frequent secondary generalization and posterior photoparoxysmal response. Other important differences included a significantly older age at seizure onset and paucity of spontaneous interictal epileptic discharges in patients with photically-induced occipital seizures; only a quarter of these had occasional occipital spikes, in contrast to the idiopathic (genetic) generalized epilepsy patients with typically generalized epileptic discharges. On the other hand, both groups shared a positive family history of epilepsy, common seizure threshold modulators (such as tiredness and sleep deprivation), normal neurological examination and MRI, a generally benign course, and good response to valproic acid. We demonstrated that photosensitivity can first occur in adult life and manifest, either as idiopathic (possibly genetic) photosensitive occipital epilepsy with secondary generalization or as an EEG, and less often, a clinical/EEG feature of idiopathic (genetic) generalized epilepsies. Identification of idiopathic photosensitive occipital epilepsy fills a diagnostic gap in adult first-seizure epileptology and is clinically important because of its good response to antiepileptic drug treatment and fair prognosis.

Myoclonic occipital photosensitive epilepsy with dystonia (MOPED): A familial epilepsy syndrome

To describe clinical and EEG phenotypes of a family with an unusual familial epilepsy syndrome characterized by myoclonus and dystonia. Family members underwent electroclinical phenotyping including review of EEGs and MRI. DNA from family members was genotyped using Illumina OmniExpress genotyping arrays. Parametric and nonparametric linkage analyses were performed using MERLIN. The disorder followed autosomal dominant (AD) inheritance and affected seven individuals over two generations. Seizures began at a mean of 14.5 years. Six individuals had spontaneous myoclonic seizures, of which five also had photic-induced myoclonus and four had photic-induced occipital seizures. Six individuals had convulsive seizures; generalized in two and focal in four. Photosensitivity was prominent with generalized spike wave and polyspike wave in four individuals of which two also had occipital spikes. MRI scans were normal in the four individuals tested. Extensive metabolic investigation was normal. Juvenile myoclonic epilepsy (JME) occurred in two; and JME overlapping with idiopathic photosensitive epilepsy (IPOE) in four individuals. All three affected males had a more severe disorder than the four affected females. Two males had a progressive neurological disorder with progressive myoclonus epilepsy and deterioration in their early 30s. They developed episodes of paroxysmal cervical dystonia with cognitive decline during periods of poor seizure control. One plateaued after years of poor seizure control but remained intractable with periods of deterioration. The other deteriorated with episodes of status dystonicus and status epilepticus, ataxia and a progressive ophthalmoplegia before succumbing at 38 years. Parametric linkage analysis identified three peaks achieving a maximum LOD score of 1.21. Nonparametric analysis identified eight peaks achieving LOD scores above 0.80. These were not statistically significant. This is a novel autosomal dominant familial epilepsy syndrome. "Myoclonic occipital photosensitive epilepsy with dystonia" (MOPED) involves a spectrum of phenotypes from JME, sometimes with an IPOE overlap, to progressive myoclonus epilepsy with paroxysmal dystonia.

Early Onset Benign Occipital Epilepsy (Panayiotopoulos syndrome): a case Report & Literature Review

Panayiotopoulos syndrome is a type of benign childhood epilepsy syndrome characterized by episodic autonomic and mainly emetic symptoms. It predominantly affects children of 3-6 years of age (13% of those with one or more non-febrile seizures). EEG shows great variability, with occipital, extra-occipital spikes or brief generalised discharges alone or in combination; it may also be consistently normal. Despite the high prevalence of autonomic status epilepticus, the prognosis of Panayiotopoulos syndrome is usually excellent and most do not require anti epileptic medications. Remission usually occurs within 1-2 years from onset. One third have a single seizure but 5-10% may have more than 10 seizures or a more prolonged course. We present a 5 year old boy with this condition, who presented with episodes of severe vomiting, deviation of eyes, focal seizure, altered sensorium, characteristic EEG in the form of multiple occipital spikes and normal neuroimaging studies.J. Natl Inst. Neurosci Bangladesh 2015;1(1):27-30

A comparison of occipital and temporal lobe epilepsies.

Differentiating between occipital lobe epilepsy (OLE) and temporal lobe epilepsy (TLE) is often challenging. This retrospective case-control study compares OLE to TLE and explores markers that suggest the diagnosis of OLE. We queried the Jefferson Epilepsy Center surgery database for patients who underwent a resection that involved the occipital lobe. For each patient with OLE, three sequential case-control patients with TLE were matched. Demographic characteristics, symptoms, electrophysiological findings, imaging findings, and surgical outcome were compared. Nineteen patients with OLE and 57 patients with TLE were included in the study. Visual symptoms were unique to patients with OLE (8/19) and were not reported by patients with TLE (P < 0.0001). Occipital interictal spikes (IIS) were found only in one-third of the patients with OLE (6/19) and in no patients with TLE (P < 0.0001). IIS in the posterior temporal lobe were found in five of 19 patients with OLE vs one of 57 patients with TLE (P = 0.003). IIS involved more than one lobe of the brain in most patients with OLE (11/19) but only in nine of 57 the TLE group. (P = 0.0003) Multilobar resection was needed in most patients with OLE (15/19), typically including the temporal lobe, but in only one of the patients with TLE (P < 0.0001). Occipital lobe epilepsy is difficult to identify and may masquerade as temporal lobe epilepsy. Visual symptoms and occipital findings in the EEG suggest the diagnosis of OLE, but absence of these features, does not exclude the diagnosis. When posterior temporal EEG findings or multilobar involvement occurs, the diagnosis of OLE should be considered.