The recent ILAE classification of “childhood epilepsy with occipital paroxysms. (CEOP)” into two distinct syndromes was tested at the Schneider Children’s Medical Center, Tel Aviv University, and Rappaport Medical School, Haifa, Israel. Of patients with partial-onset seizures and interictal occipital spikes referred to the pediatric seizure unit between Jan 1975 and May 1997, 134 met criteria for CEOP. Three clinical groups were defined: Group 1 (visual) with ictal visual symptoms (24 patients (18%)); Group 2 (adversive) with tonic eye deviation (72 patients (54%)); Group 3 (nonvisual, nonadversive) with various seizure patterns (38 patients (28%). Two syndromes were identified: 1) Gastaut type, late onset (median age 8 years), with brief and frequent diurnal seizures, included the Group 1 visual type; and 2) the Panayiotopoulos type, early onset (median age 5 years), with ictal eye deviation and ictal vomiting, infrequent nocturnal seizures, included the patients in Group 2 adversive type. The patients in Group 3 did not satisfy criteria for either syndrome. 
COMMENT. The authors conclude that Panayiotopoulos syndrome is the most common variant of CEOP, and the symptoms are sufficiently delineated to justify classification separate from the Gastaut type CEOP and, also, from BECT, another idiopathic localization-related epilepsy. For all these idiopathic epilepsy syndromes, the prognosis is generally good.
Occipital epileptiform discharges in the EEG can also be associated with symptomatic epilepsies that carry a poor prognosis. Background slowing in the EEG is predictive of persistent seizures and developmental delay (see Ped Neur Briefs Aug 1999;13:63).