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Visual disturbances representing occipital lobe epilepsy in patients with cerebral calcifications and coeliac disease: a case series

¹ Department of Neuroscience, Alfred Hospital, Melbourne, Victoria, Australia
² Department of Neurology, St Vincent’s Hospital, Melbourne, Victoria, Australia
³ Department of Radiology, St Vincent’s Hospital
⁴ The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia

Correspondence to:
Correspondence to:
Dr M M Pfaender
Department of Neuroscience, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; mona_pfaender{at}hotmail.com

ABSTRACT
Paroxysmal visual manifestations may represent epileptic seizures arising from the occipital lobe. In coeliac disease (CD) bilateral occipital calcifications and seizure semiology consistent with an occipital origin have been described, primarily in Mediterranean countries. By reporting three adult patients from an Australian outpatient clinic with visual disturbances, occipital cerebral calcifications, and CD, this study seeks to emphasise that CD should be considered even when patients of non-Mediterranean origin present with these symptoms. Seizure types included simple partial, complex–partial, and secondarily generalised seizures. The seizure semiology consisted of visual disturbances such as: blurred vision, loss of focus, seeing coloured dots, and brief stereotyped complex visual hallucinations like seeing unfamiliar faces or scenes. Symptoms of malabsorption were not always present. Neurological examination was unremarkable in two patients, impaired dexterity and mild hemiatrophy on the left was noted in one. Routine electroencephalography was unremarkable. In all cases, computed tomography demonstrated bilateral cortical calcification of the occipital-parietal regions. Magnetic resonance imaging showed no additional lesion. All patients had biopsy confirmed CD. Seizure control improved after treatment with gluten free diet and anticonvulsants. This report illustrates the association between seizures of occipital origin, cerebral calcifications, and CD even in patients not of Mediterranean origin.

Abbreviations: CD, coeliac disease; CT, computed tomography; EEG, electroencephalography; MRI, magnetic resonance imaging

Keywords: cerebral calcification; coeliac disease; occipital lobe epilepsy; visual disturbances