Occipital seizures typically produce unformed positive visual phenomena, such as colored or swirling lights or a whiting out of vision, like “bubbles” or “a flashbulb going off.” However, some patients experience negative visual symptoms, typically described as a blacking out of vision. These episodes usually last a few seconds to minutes, although they may persist for many hours (status epilepticus amauroticus). Most adults with occipital seizures harbor a structural lesion (eg, tumor, arteriovenous malformation, or trauma); in children, such seizures are more often benign. A normal electroencephalogram does not rule out seizures; prolonged electroencephalogram monitoring may be required. The visual symptoms resolve with anticonvulsant therapy.
Kun Lee S, Young Lee S, Kim DW, Soo Lee D, Chung CK. Occipital lobe epilepsy: clinical characteristics, surgical outcome, and role of diagnostic modalities. Epilepsia. 2005;46(5): 688–695.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.