PHOTOSENSITIVE OCCIPITAL LOBE EPILEPSY (POLE)

Overview
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Seizure Classification
Generalized onset seizure
- Motor Onset
- Non-Motor Onset
Focal Onset Seizure
- By Onset Feature
- Focal to Bilateral Tonic-Clonic
- Hemispheric lateralization
- Lobar localization
  - Frontal
  - Temporal
  - Parietal
  - Occipital
Unknown Onset Seizure
Neonatal Seizure
Epilepsy Classification
Generalized Epilepsy
Focal Epilepsy
Generalized and Focal Epilepsy
Unknown Epilepsy
Epilepsy Syndromes
Neonate/Infant
- Self-limited
- With developmental and epileptic encephalopathy
Childhood
- Self-limited focal epilepsy syndromes
  - Remission expected in all cases by adolescence
    - Self-limited epilepsy with centrotemporal spikes
    - Self-limited epilepsy with autonomic seizures
  - Remission expected in most cases by adolescence
    - Childhood occipital visual epilepsy
    - Photosensitive occipital lobe epilepsy
- Genetic generalised epilepsy syndromes
  - Epilepsy with eyelid myoclonia
  - Epilepsy with myoclonic absence
- Idiopathic generalised epilepsy syndrome
  - Childhood absence epilepsy
- With developmental and/or epileptic encephalopathy
Variable Age
- Idiopathic generalised epilepsy syndromes
- Focal epilepsy syndromes
- Combined generalised and focal epilepsy syndrome
  - Epilepsy with reading-induced seizures
- With developmental and/or epileptic encephalopathy or progressive neurological deterioration
  - Progressive myoclonus epilepsies
  - Rasmussen syndrome
Epilepsy Etiologies
Genetic Etiologies
- Chromosomal abnormalities
- Gene abnormalities
Structural Etiologies
- Malformations of cortical development
- Vascular malformations
- Hippocampal sclerosis
- Hypoxic-Ischemic
- Traumatic brain injury
- Tumors
- Porencephalic Cyst
Metabolic Etiologies
Immune Etiologies
Infectious Etiologies
Unknown Etiologies
Encephalopathy
Epilepsy imitators

PHOTOSENSITIVE OCCIPITAL LOBE EPILEPSY (POLE)

Mandatory seizures

Photic (light) triggered focal sensory visual seizures - visual phenomena include lights, colored spots, formed visual hallucinations, or visual blurring/loss that moves across the visual field while the patient is aware. There may be head/eye version (as the patient tracks the visual phenomena).

Seizures are typically brief (<3 minutes), although prolonged seizures can occur. The frequency of seizures varies from individual to individual, relating to variations in an individuals threshold for light induction.

May have

Focal aware sensory visual seizures may evolve to have autonomic features (e.g. vomiting), impaired awareness or to a focal to bilateral tonic-clonic seizure

Focal sensory visual seizures may occur spontaneously (without light-induction)

Due to overlap with the idiopathic generalized epilepsies, generalized tonic-clonic, myoclonic or absence seizures may occur