Benign occipital lobe seizures: Natural progression and atypical evolution
A 13-year-old boy presented with a history of seizures since the age of 5 years. Seizures initially started as brief episodes of blurring of vision. Corrective glasses for refractory error did not stop the episodes. Single seizure involving the left side prompted commencement of treatment with valproate syrup [], which made him seizure free for 2 years, but recurred. At the time, seizures were characterized by fear and cry, saying “save me” followed immediately by few seconds of blindness and then automatism of the hands. The boy would be responsive during the brief episodes, but less responsive during prolonged episodes with automatism. There is no available documentation of loss of vision post-event.\nAlthough there is no cry now, semiology is similar for brief episodes. Prolonged episodes have additional clenching of both fists with tonic posturing of arms more than legs. Sometimes, there is forced head turn mainly to the left accompanied by continuous eyelid fluttering and this could evolve into secondary generalized seizures. The duration lasts from 1-3 min. With secondary generalization, postictal confusion lasts for 20-30 min without any blindness.\nSeizures have gradually increased in frequency over the years from once every month to once every week and now to everyday seizures occurring in clusters leading to postictal drowsiness. The hallmark feature is the blurring of vision during these seizures.\nThroughout this course, his general behavior has been normal, but school performance was below average []. As the boy continued to have daily seizures, parents withdrew him from school. He was initially treated with sodium valproate (VAP) alone then levetiracetam was added followed by lamotrigine (LTG) after withdrawing VAP. He was also treated with oxcarbazepine during the initial periods, but stopped due to unknown reason [].\nIn 2012, when he presented to us with history of daily seizures, he was on levetiracetam, LTG and clobazam [].\nCarbamazepine 200 mg BD was added as part of the polytherapy. Now his seizures are less frequent, 1-2/week without secondary generalization, but not fully controlled. Patient was diagnosed as occipital seizures in 2009. Imaging studies have not shown evidence for any focal lesions including positron emission tomography (PET) computed tomography (CT) [].\nThe boy is more interactive with better seizure control and is willing to start school again.