Seizures arising in the occipital lobe are characterized by visual aura that are subjective leading to difficulty in diagnosis in young children. Oculomotor features may also occur such as forced eye closure, eyelid fluttering, eye deviation and nystagmus. There is often involvement of other lobes as the seizure spreads.
Seizures in this area result in elemental visual auras, these may be positive phenomena (typically multi-colored shapes such as circles, flashes), or negative phenomena such as loss of a part of a visual field or blindness (amaurosis). Bilateral loss of vision may occur and this may be in the form of a black-out or a white-out. More complex formed visual images are not seen in seizures arising in this area. The visual aura is seen in the contralateral visual field to the hemisphere of seizure onset. If positive visual phenomena occur in a part of the visual field, the person may be seen to look in that direction during the seizure. It can be helpful to ask a young child to draw what they see during their seizure. Visual aura are usually brief (< 2 minutes) which can assist in distinguishing them from migraine aura (5-15 minutes).
Seizures in this area are associated with more complex formed visual hallucinations such as pictures of people, animals or scenes.
Epileptic nystagmus may be seen. If nystagmus is seen, this is typically with the fast component to the side contralateral to the hemisphere of seizure onset and the slow component returning to the ipsilateral side. Eye movements typically occur with retained awareness, and may be accompanied by head or trunk version. There may also be eyelid flutter or forced eyelid closure.
Occipital seizures arising in this area tend to spread to the temporal lobe producing dyscognitive features.
Occipital seizures arising in this area can spread to the parietal lobe, fronto-parietal operculum or frontal lobes. Atonic motor features can occur if the seizure spreads rapidly to frontal regions.