Extraoccipital benign childhood partial seizures with ictal vomiting and excellent prognosis

In a previous report of 900 patients with epileptic seizures, 24 children had ictal vomiting. Twelve had a previously unrecognised syndrome of early onset benign childhood occipital seizures (EBOS) and three had symptomatic epilepsy. The other nine children with extraoccipital EEG foci or normal EEG are described in this paper based on a prospective follow up for a median of 9 years after their first seizure. All had normal neurology, mental state, and development. All seizures of all but one patient occurred in sleep. Seizures manifested with ictal vomiting (nine), deviation of the eyes (four), speech arrest (three), hemiconvulsions (five), oropharyngolaryngeal symptoms, and hypersalivation (one) with or without impairment of consciousness. Median age at onset was 5 years, seizures were infrequent and remitted at a median age of 6. Four children had a single fit, four had two to three, and only one child had many seizures before the initiation of treatment. This study certifies that idiopathic childhood partial seizures with ictal vomiting may occur with EEG spike foci in other than the occipital regions or EEG may be normal. Despite some clinico-EEG differences from the EBOS, childhood seizures with ictal vomiting, and extraoccipital EEG foci are of equally excellent prognosis. Their existence on the border between rolandic and occipital seizures is consistent with a unified concept of a benign childhood partial seizure susceptibility syndrome.