Favorable outcome of epileptic blindness in children.
Acute blindness is a rare presentation of epileptic seizures, referring to loss of sight without loss of consciousness associated with electroencephalographic (EEG) epileptic discharges, mainly representing an ictal phase but also either pre- or postictal. We report a series of 14 children with documented epileptic blindness, describing the accompanying fits and thereafter the response to therapy to resolve the blindness and control associated seizures. All patients experienced episodes of acute complete visual obscuration lasting for 1 to 10 minutes. Seven patients hadaccompanying generalized seizures, with a photosensitive response recorded in three of them. All of these seven children were treated with valproic acid, regaining full vision, and six of them became seizure free. Three patients with acute blindness who had accompanying focal motor seizures and unilateral temporooccipital posterior epileptic discharges were treated with carbamazepine regained full vision and complete seizure control. Four additional children had the constellation of migrainous headaches, focal motor phenomena, and complete blindness, along with occipital discharges compatible with Gastaut syndrome, benign childhood epilepsy with occipital paroxysms. All four patients were started on carbamazepine and became asymptomatic. Our overall experience suggests that epileptic blindness in children is associated with a favorable outcome when promptly diagnosed and treated appropriately, resulting in complete resolution of blindness in all children and satisfactory control of seizures in most of them. We therefore recommend performing a prompt EEG in any child presenting with acute visual obscuration, even in the absence of other epileptic phenomena.
Shahar
Eli
E
Child Neurology Unit and Epilepsy Service, Meyer Children's Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa 31096, Israel. e_shahar@rambam.health.gov.il
Barak
Shai
S
D000208:Acute Disease; D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D019575:Blindness, Cortical / Q000175:diagnosis* / Q000188:drug therapy; D002220:Carbamazepine / Q000627:therapeutic use; D002648:Child; D004569:Electroencephalography / Q000187:drug effects; D004831:Epilepsies, Myoclonic / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D004828:Epilepsies, Partial / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D004827:Epilepsy / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D004829:Epilepsy, Generalized / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D020195:Epilepsy, Reflex / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D004833:Epilepsy, Temporal Lobe / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D002220:Carbamazepine; D014635:Valproic Acid