CHILDHOOD OCCIPITAL EPILEPSY (GASTAUT TYPE)

Overview
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Seizure Classification
Generalized onset seizure
- Motor Onset
- Non-Motor Onset
Focal Onset Seizure
- By Onset Feature
- Focal to Bilateral Tonic-Clonic
- Hemispheric lateralization
- Lobar localization
  - Frontal
  - Temporal
  - Parietal
  - Occipital
Unknown Onset Seizure
Epilepsy Classification
Generalized Epilepsy
Focal Epilepsy
Generalized and Focal Epilepsy
Unknown Epilepsy
Epilepsy Syndromes
Neonatal/Infantile
- Self-limited neonatal seizures and Self-limited familial neonatal epilepsy
- Self limited familial and non-familial infantile epilepsy
- Early myoclonic encephalopathy
- Ohtahara syndrome
- West syndrome
- Dravet syndrome
- Myoclonic epilepsy in infancy
- Epilepsy of infancy with migrating focal seizures
- Myoclonic encephalopathy in non-progressive disorders
- Febrile seizures plus, genetic epilepsy with febrile seizures plus
Childhood
- Epilepsy with myoclonic-atonic seizures
- Epilepsy with eyelid myoclonias
- Lennox-Gastaut syndrome
- Childhood absence epilepsy
- Epilepsy with myoclonic absences
- Panayiotopoulos syndrome
- Childhood occipital epilepsy (Gastaut type)
- Photosensitive occipital lobe epilepsy
- Childhood epilepsy with centrotemporal spikes
- Atypical childhood epilepsy with centrotemporal spikes
- Epileptic encephalopathy with continuous spike-and-wave during sleep
- Landau-Kleffner syndrome
- Autosomal dominant nocturnal frontal lobe epilepsy
Adolescent/Adult
- Juvenile absence epilepsy
- Juvenile myoclonic epilepsy
- Epilepsy with generalized tonic-clonic seizures alone
- Autosomal dominant epilepsy with auditory features
- Other familial temporal lobe epilepsies
Any Age
- Familial focal epilepsy with variable foci
- Reflex epilepsies
- Progressive myoclonus epilepsies
Epilepsy Etiologies
Genetic Etiology
- Chromosomal abnormalities
- Gene abnormalities
Structural Etiology
- Malformations of cortical development
- Vascular malformations
- Hippocampal sclerosis
- Hypoxic-Ischemic
- Traumatic brain injury
- Tumors
- Porencephalic Cyst
Metabolic Etiology
Immune Etiology
- Rasmussen syndrome
- Antibody mediated
Infectious Etiology
Unknown Etiology
- Febrile infection related epilepsy syndrome
Epilepsy imitators

CHILDHOOD OCCIPITAL EPILEPSY (GASTAUT TYPE)

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.