Short report
Elementary visual hallucinations, blindness, and headache in
idiopathic occipital epilepsy: differentiation from migraine
Department of
Clinical Neurophysiology and Epilepsies, St Thomas' Hospital, London,
UK
Correspondence to: Dr C P Panayiotopoulos, St Thomas' Hospital, London SE1 7EH, UK. Telephone 0044 171 9228221; fax 0044 171 9228263.
Received 7 May and in revised form 2 October 1998;
Accepted 16 October 1998
This is a qualitative and chronological analysis of ictal and
postictal symptoms, frequency of seizures, family history, response to
treatment, and prognosis in nine patients with idiopathic occipital epilepsy and visual seizures. Ictal elementary visual hallucinations are stereotyped for each patient, usually lasting for seconds. They
consist of mainly multiple, bright coloured, small circular spots,
circles, or balls. Mostly, they appear in a temporal hemifield often
moving contralaterally or in the centre where they may be flashing.
They may multiply and increase in size in the course of the seizure and
may progress to other non-visual occipital seizure symptoms and more
rarely to extra-occipital manifestations and convulsions. Blindness
occurs usually from the beginning and postictal headache, often
indistinguishable from migraine, is common. It is concluded that
elementary visual hallucinations in occipital seizures are entirely
different from visual aura of migraine when individual elements of
colour, shape, size, location, movement, speed of development,
duration, and progress are synthesised together. Postictal headache
does not show preference for those with a family history of migraine.
Most of the patients are misdiagnosed as having migraine with
aura, basilar migraine, acephalgic migraine, or migralepsy simply
because physicians are not properly informed of differential
diagnostic criteria. As a result, treatment may be delayed for
years. Response to carbamazepine is excellent and seizures may remit.
© 1999 by Journal of Neurology, Neurosurgery, and Psychiatry
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