Childhood occipital idiopathic epilepsy

Clinical history: A 4-year-old boy was admitted to our unit 2 hours after his first seizure, which was characterized by vomiting, headache, and unresponsiveness. The attack occurred during sleep and lasted 25 minutes. General history: Family history for febrile seizures. Normal psychomotor development. Examination Neurological examination was normal. Special studies The child underwent repeated video-EEG recordings, while awake and asleep (10-20 International Electrode Placement System, including the Oz electrode) with intermittent photic stimulation (IPS) and hyperventilation. EEG showed normal background activity with bilateral temporo-occipital spikes and wave discharges, with right predominance and activated during sleep. IPS evoked no EEG change. 1.5 T brain MRI was normal. During a routine follow-up EEG, the child happened to manifest his third seizure, which occurred during sleep (stage 2, non-REM sleep). At seizure onset, interictal EEG abnormalities ceased to be replaced after 2 minutes by an irregular rhythmic 4Hz activity building up over the right occipital leads and rapidly involving the contralateral occipital region. Six minutes after its onset, the ictal discharge became more diffuse and with sharper outline, especially on right occipital and Oz leads. Seven minutes and 30 seconds after onset, the respirogram started to show recurrent apneas lasting 6-7 seconds each. After 10 minutes 20 seconds, the child opened his eyes, blinking for few seconds and started to chew and retch, and turned his head and eyes to the left. The behavioral arousal was accompanied in the EEG by a spike discharge that gradually spread to both hemispheres, with intermingled faster rhythms on the right occipital leads and at Oz. At 11 minutes 40 seconds, the child started vomiting and deviated his eyes and head to the left. He was able to name objects, describe their colors, and perform simple motor tasks upon request. He repetitively tried to turn his head towards his father on the right side, but, after a few seconds, again deviated his head and eyes to the left. Vomiting reappeared intermittently four times over the following 10 minutes. At 22 minutes, the child was unable to sit and pick up his arms, but continued to correctly answer simple questions. The seizure was stopped 34 minutes after its onset using endorectal diazepam.