Occipitotemporal seizures induced by intermittent photic stimulation in three children with brain injuries, aged 10 to 13 years, are reported from the Institute of Developmental Neuropsychiatry, University of Pisa, Italy. Infantile or early childhood seizures (infantile spasms, febrile seizures, or complex partial seizures) had been controlled and medications discontinued. All had a history of occipital spikes on the EEG. Photic stimulation induced electroclinical phenomena localized to the right occipital lobe with spread to mesial temporal limbic structures, including amygdala and hippocampus. Symptoms began with blindness, tonic eye deviation, blinking, oral automatisms, epigastric sensations, fear, reduced responsiveness, rhythmic chewing, and vomiting, appearing as a late ictal manifestation. All patients were seizure free at 1 year follow up; 2 were untreated and one had received carbamazepine. Vomiting can be a late ictal phenomenon resulting from temporal lobe spread of seizures originating in the occipital lobe. [1]

COMMENT. Vomiting as an ictal phenomenon is controversial and difficult to distinguish from migraine. In these patients with previous evidence of occipital epileptiform EEG discharges, visual symptoms followed by automatisms and vomiting appeared more likely to result from temporal lobe ictal involvement than a migraine secondary to an occipital seizure. The lateralization of the ictal discharge to the right hemisphere has previously been reported in 13 children with the diagnosis of ictus emeticus. (Kramer RE et al, 1988). Cyclical vomiting as a form of epilepsy in 33 children was described in 1955. (Millichap JG, Lombroso CT, Lennox WG). See Progress in Pediatric Neurology, Chicago, PNB Publishers, 1991, for further reports of ictus emeticus.