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Mandatory seizures

Focal sensory visual seizures occur from awake states, these have rapid onset, are brief (typically seconds, most < 3 minutes, rarely up to 20 minutes) but frequent without treatment. Typically elementary visual phenomena occur, described as small multi-coloured circles seen in the peripheral vision, increasing in area of the visual field involved and moving horizontally to the other side. This may be followed by deviation of the eyes or turning of the head (to the side ipsilateral to the hemisphere of seizure onset).

May have

Other occipital lobe seizure features may occur, including ictal blindness, complex visual hallucinations, visual illusions (e.g. of ocular movement), orbital pain, eyelid fluttering or repetitive eye closure, ictal headache or nausea and vomiting. Post-ictal headache is common (seen in 50%), and may be associated with nausea and vomiting (10%, especially if seizure networks are in the non-dominant hemisphere).

The seizure may spread outside the occipital lobe resulting in hemiparaesthesia, impaired awareness features (14%), a hemiclonic (43%) or focal to bilateral tonic-clonic (13%) seizure.

Typical absence seizures may occur in some patients after the onset of occipital seizures.

CAUTION If seizures with impaired awareness are frequent right arrow consider structural brain abnormality.

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