Epilepsia, 48(11):2181–2186, 2007 doi: 10.1111/j.1528-1167.2007.01265.x BRIEF COMMUNICATION A Case with Atypical Childhood Occipital Epilepsy “Gastaut Type”: An Ictal Migraine Manifestation with a Good Response to Intravenous Diazepam * §Pasquale Parisi, †‡§Doroth ´ ee GA Kasteleijn-Nolst Trenit´ e, †§Marta Piccioli, * Andrea Pelliccia, * Anna Luchetti, †Carla Buttinelli, and * Maria Pia Villa * Child Neurology & Pediatric Sleep Centre, Chair of Pediatrics La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Rome, Italy; †Chair of Neurology La Sapienza University, II Faculty of Medicine Sant’Andrea Hospital, Rome, Italy; and ‡Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands 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 fol- lowed 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 af- ter 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 ap- peared 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 exten- sive intermittent photic stimulation (IPS), 2 days after the status migrainosus, evoked besides asym- metrical 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 parietotem- poral sharp-waves were seen. This lasted for about 10 min. Later, an interictal routine EEG was nor- mal except for some theta over the right tem- porooccipital 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 migra- neous features. KEY WORDS: Migraine—Occipital epilepsy— Autonomic status epilepticus—Intermittent photic stimulation—Visual sensitivity. CASE REPORT A 14-year-old girl was admitted to the first aid be- cause of a generalized tonic–clonic seizure in the school Accepted July 7, 2007; Online Early publication August 17, 2007. 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 §These Authors contributed equally. This work was supported by the Marie Curie Grant MEXC-CT-2005- 24224: Visual Sensitivity. Blackwell Publishing, Inc. C  2007 International League Against Epilepsy bus after having visited the exhibition of Bonnard and Matisse in Rome. Before this excursion she had video gamed for hours on the new home TV (flat screen with bright colors and contrast). This had given her headache on the right backside of the head without any other symp- toms or signs lasting about 3 h before the seizure onset. Her clinical history revealed only sporadic (2–4/year) mi- graine attacks without aura. Moreover, she has never had any visual disturbance or vertigo. The tonic–clonic seizure started with elevation of the left arm and head deviation to the right, followed by loss of consciousness with cyanosis and massive jerking. Examination in the hospital (post- ictally) revealed no abnormalities except anisocoria (left > right) and persistence of her headache complaints. MRI 2181