CASE OF SIMPLE PARTIAL STATUS EPILEPTICUS IN OCCIPITAL LOBE EPILEPSY MISDIAGNOSED AS MIGRAINE - CLINICAL, ELECTROPHYSIOLOGICAL, AND MAGNETIC-RESONANCE-IMAGING CHARACTERISTICS

A 31-year-old man had a unique form of occipital lobe epilepsy. Since age 13 years, he has had episodes of simple partial status epilepticus (SE) occurring twice a month. These typically consisted of elementary visual hallucinations of flashing lights obscuring his left visual fi eld for a period of 2 days, associated with a severe frontal headache initially diagnosed as migraine. These episodes of simple partial SE t hen evolved to a complex partial seizure (CPS) or secondarily generali zed seizure. There were unique EEG features, including: (a) the percep tion of a flash of light in the left visual field with a single sharp/ slow wave discharge over the right occipital lobe, (b) right occipital lobe epileptiform activity during the prolonged aura, and (c) an abno rmal response to photic stimulation, with occipital lobe discharges du ring Low rates of stimulation (3-5 Hz), time-locked to the stimulus. H igh-resolution magnetic resonance imaging (MRI) with quantitative morp hometry demonstrated that the right hemisphere and right caudate nucle us were smaller than those on the left. An abnormal gyral pattern was also noted over the right parietal region. Occasionally, distinguishin g occipital lobe epilepsy from migraine may be difficult.