A Case with Atypical Childhood Occipital Epilepsy “Gastaut Type”: An Ictal Migraine Manifestation with a Good Response to Intravenous Diazepam

Authors

  • Pasquale Parisi,

    1. Child Neurology & Pediatric Sleep Centre, Chair of Pediatrics La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Rome, Italy
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      These Authors contributed equally.

  • Dorothée GA Kasteleijn-Nolst Trenité,

    1. Chair of Neurology La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Rome, Italy
    2. Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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      These Authors contributed equally.

  • Marta Piccioli,

    1. Chair of Neurology La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Rome, Italy
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    • §

      These Authors contributed equally.

  • Andrea Pelliccia,

    1. Child Neurology & Pediatric Sleep Centre, Chair of Pediatrics La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Rome, Italy
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  • Anna Luchetti,

    1. Child Neurology & Pediatric Sleep Centre, Chair of Pediatrics La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Rome, Italy
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  • Carla Buttinelli,

    1. Chair of Neurology La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Rome, Italy
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  • Maria Pia Villa

    1. Child Neurology & Pediatric Sleep Centre, Chair of Pediatrics La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Rome, Italy
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  • This work was supported by the Marie Curie Grant MEXC-CT-2005-24224: Visual Sensitivity.

Address correspondence and reprint requests to Pasquale Parisi, M.D., Ph.D., Child Neurology & Pediatric Sleep Centre, Chair of Pediatrics, La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy. E-mail: parpas@iol.it., pasquale.parisi@uniroma1.it

Summary

We report the history of a 14-year-old girl with atypical childhood occipital epilepsy “Gastaut type” whose first generalized tonic–clonic seizure was preceded by migraine without aura and followed by a status migrainosus. This status lasted for 3 days despite standard analgesic therapy. An EEG recording revealed an occipital status epilepticus during her migraine complaints. Seven minutes after intravenous administration of 10 mg diazepam under continuous EEG recording, a suppression of the epileptiform discharges over the right occipital was seen, while the headache subsided 3 min later. After precise questioning about the circumstances that possibly could have led to these events, it appeared that she had played for hours with a play station on the new color TV and she had visited an exhibition of Matisse and Bonnard with bright colors and contrast-rich text. Standardized extensive intermittent photic stimulation (IPS), 2 days after the status migrainosus, evoked besides asymmetrical right-sided driving, green spots in her left visual field, while in the EEG sharp waves were recorded over the right parietotemporal region. After further IPS with 20 Hz (eye closure), she started complaining of a light pulsating headache right occipitally and in the EEG right parietotemporal sharp-waves were seen. This lasted for about 10 min. Later, an interictal routine EEG was normal except for some theta over the right temporooccipital area. The most likely diagnosis is an atypical form of occipital epilepsy “Gastaut type.” We would therefore advocate recording EEGs with photic stimulation in patients with atypical migraneous features.

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