Caraballo Roberto, Koutroumanidis Michael, Panayiotopoulos Chrysostomos P, Fejerman Natalio
Neuropediatric Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
J Child Neurol. 2009 Dec;24(12):1536-42. doi: 10.1177/0883073809332395.
The purpose of this review is to provide guidance for appropriate diagnosis and management of idiopathic childhood occipital epilepsy of Gastaut. The typical clinical features are visual seizures that typically consist of brief elementary visual hallucinations, which are mainly multicolored and circular. Ictal blindness and deviation of the eyes are also common symptoms. The seizures are usually frequent and diurnal. The electroencephalography is the only investigation with abnormal results, showing occipital spikes and often occipital paroxysms demonstrating fixation-off sensitivity. Brain magnetic resonance imaging is used to exclude symptomatic occipital epilepsy. Patients usually respond well to antiepileptic medication and about two-thirds remit by the age of 16 years. Idiopathic childhood occipital epilepsy of Gastaut is frequently misdiagnosed as migraine with visual aura, acephalgic, or basilar migraine. Differentiation from symptomatic occipital epilepsy, particularly when children are otherwise normal, can be difficult. Most children need prophylactic antiepileptic medication.
本综述的目的是为儿童特发性加斯东型枕叶癫痫的恰当诊断和管理提供指导。典型的临床特征为视觉发作，通常由短暂的基本视幻觉组成，主要为多色且呈圆形。发作性失明和眼球偏斜也是常见症状。发作通常频繁且多在白天。脑电图是唯一结果异常的检查，显示枕叶棘波，且常出现枕叶阵发性放电，表现出闭眼敏感性。脑磁共振成像用于排除症状性枕叶癫痫。患者通常对抗癫痫药物反应良好，约三分之二的患者在16岁时缓解。儿童特发性加斯东型枕叶癫痫常被误诊为伴有视觉先兆的偏头痛、无头痛性偏头痛或基底型偏头痛。与症状性枕叶癫痫进行鉴别，尤其是当儿童其他方面正常时，可能会很困难。大多数儿童需要预防性抗癫痫药物治疗。
