Adolescent onset of idiopathic photosensitive occipital epilepsy after remission of benign rolandic epilepsy.
OBJECTIVE
We describe 2 girls, aged 19 years, who experienced a rolandic seizure at ages 4 and 5, respectively, together with the interictal EEG features of benign rolandic epilepsy (BRE). In adolescence both patients developed photosensitive occipital seizures accompanied by spontaneous and photic-induced occipital EEG paroxysms.


METHODS
We have been following 33 patients with a history of BRE, between ages 12 and 28 years (mean 17 years). Twenty-one of these patients had experienced their last rolandic seizure before the age of 10 years and 9 of them had been without treatment since age 11 or earlier. In 2 of these 9 patients, other types of seizures recurred after remission of BRE. Clinical, EEG, and evoked potential findings on these 2 patients are presented.


RESULTS
After having experienced BRE, both patients suffered partial seizures from age 12, with elementary visual hallucinations, visual blurring, slow head turning, cephalic pain, epigastric discomfort, unresponsiveness, and vomiting. Seizure onset was related to watching TV or exposure to bright light. EEG showed interictal occipital spikes, and a photoparoxysmal response limited to the occipital lobes. Visual evoked potentials were greatly increased in amplitude. One patient had two visual attacks only and remained seizure free after 4 years of follow-up, while the other had seizures controlled by an association of valproate and carbamazepine.


CONCLUSIONS
Clinical and neurophysiological characteristics suggest that these two patients may have presented different age-related expressions within the spectrum of a benign seizure susceptibility syndrome rather than sharply distinct epilepsy syndromes.
Guerrini
R
R
Institute for Clinical Research Stella Maris Foundation, Calambrone, Pisa, Italy.
Bonanni
P
P
Parmeggiani
L
L
Belmonte
A
A
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D019305:Epilepsy, Rolandic / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005073:Evoked Potentials, Somatosensory; D005074:Evoked Potentials, Visual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009778:Occipital Lobe / Q000503:physiopathology*; D010775:Photic Stimulation; D012890:Sleep / Q000502:physiology; D013003:Somatosensory Cortex / Q000503:physiopathology
D000927:Anticonvulsants