CHILDHOOD OCCIPITAL VISUAL EPILEPSY (COVE)

Mandatory seizures

Focal sensory visual seizures occur from the awake state, these are brief (seconds to <3 minutes, rarely up to 20 minutes) but frequent without treatment. 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.

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. Post-ictal headache is common, and may be associated with nausea and vomiting.

The seizure may spread outside the occipital lobe resulting in hemiparaesthesia, impaired awareness, a hemiclonic or focal to bilateral tonic-clonic seizure.

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

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