Figure 13.5. Video EEG samples of spontaneous EEG paroxysms and photically induced posterior or maximum posterior PPR in two children with photically induced occipital seizures.

Figure 13.5

Video EEG samples of spontaneous EEG paroxysms and photically induced posterior or maximum posterior PPR in two children with photically induced occipital seizures. They probably have IPOE. Top is case 12.1 and bottom is case 12.2 in ref 11.

Top left and middle: Spontaneous occipital spikes/polyspikes and generalised discharges are associated with eyelid fluttering, which is conspicuous on video EEG. Neither the patient nor her relatives were aware of these.

Top right: IPS consistently elicited posterior spikes, which were also associated with ictal eyelid fluttering.

This patient had typical multicoloured visual seizures from the age 5 years (case 12.1 in ref 11). They were elicited by environmental lights and occasionally progressed to GTCS. She improved over the years, but at 20 years of age and while on medication with valproate, she had a visual seizure with GTCS while watching TV from nearly touching distance. High resolution MRI was normal.

Bottom left and right: Spontaneous occipital paroxysms without discernible clinical manifestations.

Bottom right: IPS consistently elicited PPR with maximum posterior emphasis. These were often associated with conspicuous eyelid fluttering.

This patient illustrated the links between IPOE and the benign childhood seizure susceptibility syndrome (case 12.2 in ref 11). She initially had typical Rolandic seizures and then developed frequent visual seizures often with secondarily GTCS. These were sometimes photically induced, but more often occurred during sleep. High resolution MRI was normal.

From Panayiotopoulos (1999)11 with the permission of the Publisher John Libbey.

From: Chapter 13, Reflex Seizures and Reflex Epilepsies

Cover of The Epilepsies
The Epilepsies: Seizures, Syndromes and Management.
Panayiotopoulos CP.
Oxfordshire (UK): Bladon Medical Publishing; 2005.
Copyright © 2005, Bladon Medical Publishing, an imprint of Springer Science+Business Media.

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