The Girl with Visual Seizures Who wasn't Seeing Things - Transient Blindness in a Young Girl

This chapter examines the case of a girl named Lauren who was diagnosed with Gastaut-type idiopathic childhood occipital epilepsy, or Gastaut-type benign childhood epilepsy with occipital paroxysms (BCEOP). The routine EEG showed frequent right occipital spike-wave and polyspike discharges, single or in trains up to 1.5 s, with amplitudes up to 200 μ V. The posterior dominant rhythm was slightly slower on the right. Lauren was initially treated with valproic acid. Her spells subsided promptly, but returned several months later and did not respond to increasing doses. She was switched to carbamazepine with excellent results until a few breakthrough seizures prompted the addition of gabapentin. This patient presented with brief, stereotypic episodes of visual obscuration with mild confusion but preserved awareness. Her seizures are therefore complex partial in type. In this case, previous physicians either considered Lauren's symptoms to be psychogenically based, given the proximate psychosocial stressors, or else lumped her symptoms into migraine. Although it is important to consider the psychosocial factors that may contribute to a child's symptoms, ictal details should be carefully sorted out before assuming causality.