What is Benign Occipital Seizure?
Benign occipital seizures are a type of epilepsy that starts in the back of the brain, or the occipital area. These seizures typically only happen in children who are otherwise developing normally, have no neurological issues and have no structural problems with their brain. These seizures are only seen during childhood. This condition is rare and it’s unclear exactly how many children are affected.
The International League Against Epilepsy (ILAE), a global organization dedicated to preventing epilepsy, classifies this condition under childhood epilepsy syndromes. They further divide it into two categories based on the symptoms children experience. Some children have what’s called Panayiotopoulos syndrome (PS), which is characterized by symptoms associated with the body’s automatic functions, or autonomic symptoms. Other children have what’s known as idiopathic childhood occipital epilepsy of Gastaut (ICOE-G), which is marked by visual symptoms. Additionally, in a small portion of cases, children’s symptoms don’t fit into either of these categories.
What Causes Benign Occipital Seizure?
Benign occipital seizures are thought to be linked to our genes. Although doctors haven’t pinned down a precise genetic problem, these seizures are believed to occur because of a complex mix of multiple genes (a situation referred to as polygenic).
Sometimes, individuals with seizures may have a mutation in the SCN1A gene, which can result in more severe symptoms. For a type of seizure known as ICOE-G, no specific gene or chromosomal abnormality has been found.
Most children with these seizures don’t have brothers, sisters, or other family members with the same kind of seizures. However, a small percentage may have a family history of fever-induced seizures, other types of epilepsy (a neurological disorder causing seizures), and severe headaches, known as migraines.
Risk Factors and Frequency for Benign Occipital Seizure
This illness is most commonly seen in kids between the ages of 3 to 6 years, but can appear in children from 1 to 14 years old. Most children with this condition experience no more than 6 seizures in their lifetime, and half of these kids only have one seizure.
- This condition usually shows up in children between 1 and 18 years of age.
- In more than half of the patients, seizures are resolved within 4 years of beginning.
Signs and Symptoms of Benign Occipital Seizure
The syndrome in discussion is primarily marked by seizures. Unlike typical expectations, these seizures often involve effects on the body’s automatic workings and might include symptoms like nausea, vomiting, pale skin, dilated pupils, changes in body temperature or heart rate, loss of bladder control, and excessive salivation. Importantly, these seizures don’t always match traditional descriptions and may only manifest as automatic body changes. They can last longer than 30 minutes and might be perceived as “focal autonomic status epilepticus”. Even in the midst of recurring seizures, children suffering from this condition usually appear normal in between seizure episodes and tend to bounce back to normalcy after a restful sleep.
Recognizing this medical condition can be quite tricky and calls for a strong analytic eye and specialized knowledge. Its unusual symptoms often lead doctors to misdiagnose it as other conditions like non-seizure related episodes, migraines, balance disorders, or sleep disorders.
- Seizures affecting automatic bodily functions
- Symptoms including nausea, vomiting, pale skin, dilated pupils, and bodily changes
- Seizures lasting longer than 30 minutes
- Potential misdiagnosis due to atypical symptoms
Another syndrome discussed here is also identified through seizures, but this time, the seizures primarily induce visual symptoms. These can include seeing things not present (visual hallucinations), sudden blindness during a seizure (ictal blindness), pain around the eye, headaches, and feelings of nausea or vomiting. In instances where the seizure extends beyond the area at the back of the brain responsible for vision (occipital lobe), the symptoms might also involve unusual sensory experiences or motor disturbances. Some affected children may suffer from very frequent seizures, even experiencing them daily if not treated. Headaches are a common experience in about one-third of these patients, usually following the seizure.
This condition is often mistaken for migraines due to the shared characteristics of visual disturbances and headaches.
- Seizures causing visual symptoms
- Possible symptoms: visual hallucinations, ictal blindness, eye pain, headaches, nausea
- Symptoms may include sensory or motor disturbances if the seizure affects other brain regions
- Potential for frequent seizures and common occurrence of post-seizure headaches
- Often misdiagnosed as migraine
Testing for Benign Occipital Seizure
Diagnosing benign occipital epilepsy, a type of epilepsy that primarily affects the back of the brain, involves a thorough review of the patient’s medical history and analyzing brainwave patterns using a test called an electroencephalogram (EEG). Imaging tests, such as magnetic resonance imaging (MRI), can also be helpful, although they usually appear normal in patients with this condition. However, these imaging tests can help distinguish benign occipital epilepsy from other forms of epilepsy. Though not always needed, the tests are sometimes used to confirm that the epilepsy isn’t caused by another condition affecting the occipital lobe of the brain.
In addition to these tests, a doctor will also perform a comprehensive neurological examination and developmental assessment, both of which are typically normal in patients with benign occipital epilepsy.
The EEG findings in benign occipital epilepsy are quite specific. They show unique patterns in the occipital lobe of the brain, though in more than 50% of patients, unusual activity may also be seen in other areas of the brain. These patterns can appear as spikes, waves, and a specific combination of both. Because these abnormalities may not show up on every EEG, longer-term EEG monitoring might be needed if initial, brief EEG tests don’t clearly indicate a diagnosis.
Further brainwave studies have demonstrated spikes in various regions of the brain. These spikes suggest areas of increased electrical activity or “hyperexcitability.” Follow-up imaging has shown that these spikes shift over time, indicating an evolving pattern of hyperexcitability related to brain maturation. Finally, doctors also look for a specific pattern of continuous spikes and waves during sleep, which can lend additional support to the diagnosis.
Treatment Options for Benign Occipital Seizure
Doctors typically don’t recommend anti-seizure medications for seizures that are short, rare, or for patients who have fewer than 2 seizures. Usually, these medicines are given to children who have a higher risk of having more seizures. For kids with PS, a type of seizure, rescue medicines like benzodiazepines might be the best treatment choice. This is because more than half of the patients with this condition have a risk of having a specific type of seizure called “autonomic status epilepticus”, but they don’t often have frequent and long-lasting seizures.
In the case of ICOE-G, another type of seizure condition, children may have frequent seizures and thus might need anti-seizure medicines. Carbamazepine, a medication, has a more than 90% success rate and is usually the first medicine given to these children. Other possible medications include sodium valproate and phenobarbital. The need to keep taking anti-seizure medicines should be reassessed at every clinic visit. Most children don’t need to stay on anti-seizure medicines for more than 2 to 3 years.
What else can Benign Occipital Seizure be?
There are various medical conditions that might exhibit symptoms similar to those of benign occipital seizures. These include but are not limited to:
- Benign epilepsy with centrotemporal spikes (BECTS)
- Disorders that cause intermittent vomiting
- Idiopathic photosensitive occipital lobe epilepsy (IPOLE)
- Infections of the brain (encephalitis)
- Misregulated brain chemistry (metabolic encephalopathy)
- Migraine headaches
- Occipital lobe epilepsy caused by physical changes in the brain
- Fainting (syncopation)
BECTS is a common type of epilepsy in children and is another example of a good-prognosis epilepsy. Like benign occipital seizures, kids with BECTS typically grow and develop normally and have normal brain scans. The seizures in this condition start in the centrotemporal area, an area surrounding a deep groove in the brain known as the Rolandic fissure.
IPOLE is a form of light-triggered epilepsy. Those affected by it may start having seizures between the ages of 5 and 17. As a seizure begins, a child might experience basic visual disturbances. After this, they might experience a headache or stomach pain, or feel nauseous or need to vomit. It’s also possible that their consciousness will be impaired.
What to expect with Benign Occipital Seizure
The term “benign” indicates that these conditions often have a favorable outlook and in most cases, children do not require treatment. After epilepsy has been resolved, children are left with no remaining neurological problems or damage. Also, there’s no heightened chance of experiencing epilepsy when they become adults.
Possible Complications When Diagnosed with Benign Occipital Seizure
Complications are not common in children experiencing benign occipital seizures. In fact, children with ICOE-G, a specific form of this condition, are unlikely to encounter severe issues. However, if a child with PS, another specific form of seizures, experiences what is called autonomic status epilepticus, it may increase their risk of having a cardiorespiritory arrest, which is an extreme medical emergency involving the heart and lungs. Additionally, it’s important to note that the use of standard rescue treatments, like benzodiazepines, can potentially slow down the respiratory system in patients suffering from autonomic status epilepticus hence, healthcare providers may need to consider giving a lower dose.
Possible Risks Include:
- Cardiorespiratory arrest for children with PS experiencing autonomic status epilepticus
- Potential respiratory slowdown with the usage of regular dose of benzodiazepines in patients with autonomic status epilepticus.
Preventing Benign Occipital Seizure
During every check-up, it’s important to discuss potential side effects, how to properly take medication, and possible drug conflicts. These factors can change over time, so it’s crucial to keep everyone in the loop. Parents should know that children with benign occipital seizures – a type of seizure that occurs in the back of the brain – typically have excellent outcomes. These seizures usually go away before the child becomes an adult, and they don’t leave any lasting damage to the child’s brain.
