Emily was 6 years of age and came home early from school one day because she had been vomiting. She also had a bad headache. I gave her some medicine for the headache which only helped a little. She vomited several more times then finally fell asleep. This happened a few times over the next 6 months. The pediatrician thought we should see a neurologist, perhaps for migraines. When the neurologist asked Emily if she saw anything before the vomiting started, she said in a very low voice, “I saw blue and purple circles moving around”. The neurologist said that she may have migraines but wanted to do an EEG first to rule out seizures. After the test, the neurologist said that most likely she had benign occipital epilepsy. She was treated with a seizure medicine and since then hasn’t had any more episodes.
What is Benign Occipital Epilepsy (BOE)?
In this epilepsy syndrome, seizures usually begin between the ages of 5 and 7, and originate in the occipital lobe. Seizure symptoms often include:
- visual hallucinations
- loss of vision, or forced deviation of the eyes
- vomiting
The hallucinations can take any form, but tend to be of brightly colored shapes of all sizes. Children may then complain of intense headache and may have extended periods of nausea and/or vomiting. BOE can sometimes be mistaken for migraines due to the visual changes and headaches associated with this type of epilepsy. In addition to hallucinations and visual disturbances children may also experience jerking movements on one side of their body.
Important Diagnostic Findings
The EEG of a child with BOE shows spikes in the occipital region of the head during sleep, or when the eyes are closed during wakefulness. An MRI scan of the brain will be normal. By definition, BOE is not caused by a structural lesion or abnormality.
How is Benign Occipital Epilepsy Treated?
Since the seizures are of partial origin, medications such as carbamazepine and oxcarbazepine are good treatment options.
What is the Prognosis?
Children with BOE are usually neurologically normal and complete seizure control can be attained in 60% of patients.
