[Controversies and problems in the diagnosis of benign occipital epilepsies in infancy, childhood and adolescence].
OBJECTIVE
To review the changes introduced by the new proposal of diagnostic scheme for people with epilepsy made by the International League Against Epilepsy in the categorization of the idiopathic occipital epilepsies of childhood and the diagnostic challenges of these disorders.


METHODS
The term occipital paroxysms has disappeared and two major forms are distinguished: one with early onset or Panayiotopoulos type, officially recognized as a syndrome, and one with late onset or Gastaut type. To these entities we have to add the recently described idiopathic photosensitive occipital lobe epilepsy, also included in the new list of syndromes. Detailed electroencephalogram investigations are crucial to reveal all the neurophysiological diagnostic aspects of these disorders. These investigations may suggest a close relationship with rolandic epilepsies. The characterization of the Panayiotopoulos' syndrome as a focal occipital epilepsy has been questioned. The limits of the idiopathic photosensitive epilepsy with other photosensitive epilepsies are not well defined yet. The variant of Gastaut might be sometimes difficult to distinguish from migraine with visual aura. Its long term prognosis is not clear yet, in part because this overlap with other entities. The persistence of seizures beyond adolescence in some patients and the development of learning disorders and mild cognitive dysfunction cast some doubts about its good prognosis.


CONCLUSIONS
The characterization of the idiopathic occipital epilepsies and its relationships with other childhood epilepsies are a fascinating area of development in epileptology. Further research is necessary to define the limits of these disorders and their long-term prognosis.
Parra
J
J
Stichting Epilepsie Instellingen Nederland, "Meer en Bosch", Heemsted, Paises Bajos. jparra@sein.nl
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D004828:Epilepsies, Partial / Q000145:classification / Q000175:diagnosis*; D006801:Humans