Elementary visual hallucinations, blindness, and headache in idiopathic occipital epilepsy: differentiation from migraine

Abstract

This is a qualitative and chronological analysis of ictal and postictal symptoms, frequency of seizures, family history, response to treatment, and prognosis in nine patients with idiopathic occipital epilepsy and visual seizures. Ictal elementary visual hallucinations are stereotyped for each patient, usually lasting for seconds. They consist of mainly multiple, bright coloured, small circular spots, circles, or balls. Mostly, they appear in a temporal hemifield often moving contralaterally or in the centre where they may be flashing. They may multiply and increase in size in the course of the seizure and may progress to other non-visual occipital seizure symptoms and more rarely to extra-occipital manifestations and convulsions. Blindness occurs usually from the beginning and postictal headache, often indistinguishable from migraine, is common. It is concluded that elementary visual hallucinations in occipital seizures are entirely different from visual aura of migraine when individual elements of colour, shape, size, location, movement, speed of development, duration, and progress are synthesised together. Postictal headache does not show preference for those with a family history of migraine. Most of the patients are misdiagnosed as having migraine with aura, basilar migraine, acephalgic migraine, or migralepsy simply because physicians are not properly informed of differential diagnostic criteria. As a result, treatment may be delayed for years. Response to carbamazepine is excellent and seizures may remit.