Stormy onset of benign childhood epilepsy with occipital paroxysmal discharges

We studied six children with ages ranging from 4 to 10 years who were affec ted by childhood epilepsy with occipital paroxysms and presented after a st ormy onset with prolonged loss of consciousness for 6-14 h. In all these pa tients, seizures were preceded by visual symptoms in the form of colored ci rcular disks. A CT scan was performed immediately after the onset of sympto ms and was normal in all patients. Routine laboratory and cerebrospinal flu id examinations were normal in all patients. The interictal EEG was charact erized by continuous or sub-continuous occipital spike wave discharges, whi ch disappeared after the patients' eyes opened. We carried out a 7-year fol low-up of all these patients. Only two patients were treated with antiepile ptic drugs. The therapy (phenobarbital, clobazam) in the two patients did n ot induce changes in the EEG pattern. The first did not suffer any further seizures. The second patient had two more seizures (at 8 and 18 months from the onset) with phosphenes, confusional state, and involuntary movements f ollowed by loss of conscious ness. Among the other four patients, who did n ot receive any treatment, only one had any other seizures. The stormy onset of the syndrome described in our six patients emphasizes the extreme varia bility in the presentation of this type of childhood epilepsy. Our follow-u p confirms the good prognosis of this epilepsy even when it has a stormy on set.